Provider Demographics
NPI:1295008514
Name:KISMARTONI, OLIVIA (DVM, MPH)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:
Last Name:KISMARTONI
Suffix:
Gender:F
Credentials:DVM, MPH
Other - Prefix:
Other - First Name:LIV
Other - Middle Name:
Other - Last Name:KISMARTONI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:60 W TERRA COTTA AVE # B284
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3548
Mailing Address - Country:US
Mailing Address - Phone:312-622-6880
Mailing Address - Fax:
Practice Address - Street 1:530 DUNHAM RD
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1404
Practice Address - Country:US
Practice Address - Phone:630-584-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL090.010466174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL090.010466OtherVETERINARY LICENSE NUMBER