Provider Demographics
NPI:1093792707
Name:ALISCHOEWSKI, KERSTIN (MD)
Entity Type:Individual
Prefix:
First Name:KERSTIN
Middle Name:
Last Name:ALISCHOEWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-6524
Mailing Address - Country:US
Mailing Address - Phone:847-869-6470
Mailing Address - Fax:
Practice Address - Street 1:912 GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-6524
Practice Address - Country:US
Practice Address - Phone:847-869-6470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036090390Medicaid
ILH05750Medicare UPIN
ILK01362Medicare PIN