Provider Demographics
NPI:1184842445
Name:WELCH, KRISTEN UNDERHILL (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:UNDERHILL
Last Name:WELCH
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 1:70 E LAKE ST
Mailing Address - Street 2:SUITE 1018
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-7637
Mailing Address - Country:US
Mailing Address - Phone:312-551-0221
Mailing Address - Fax:866-248-7846
Practice Address - Street 1:70 E LAKE ST
Practice Address - Street 2:SUITE 1018
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-7637
Practice Address - Country:US
Practice Address - Phone:312-551-0221
Practice Address - Fax:866-248-7846
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry