Provider Demographics
NPI:1235375064
Name:KRISTINSDOTTIR, THORHILDUR (MD)
Entity Type:Individual
Prefix:
First Name:THORHILDUR
Middle Name:
Last Name:KRISTINSDOTTIR
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:UW HOSPITAL AND CLINICS
Mailing Address - Street 2:600 HIGHLAND AVE, H4/831
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53792-0001
Mailing Address - Country:US
Mailing Address - Phone:608-265-5862
Mailing Address - Fax:608-890-7127
Practice Address - Street 1:UW HOSPITAL AND CLINICS
Practice Address - Street 2:600 HIGHLAND AVE,
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-0001
Practice Address - Country:US
Practice Address - Phone:608-263-0572
Practice Address - Fax:608-890-7127
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55312390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI55312OtherFULL WISCONSIN LICENSE