Provider Demographics
NPI:1326363656
Name:BROWN, KRISTAL MAUREEN KUNITOMO (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTAL
Middle Name:MAUREEN KUNITOMO
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KRISTAL
Other - Middle Name:MAUREEN
Other - Last Name:WIMMER-KUNITOMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:375 N WALL ST STE P620
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3487
Mailing Address - Country:US
Mailing Address - Phone:815-928-5098
Mailing Address - Fax:815-936-3850
Practice Address - Street 1:375 N WALL ST STE P620
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3487
Practice Address - Country:US
Practice Address - Phone:815-928-5098
Practice Address - Fax:815-936-3850
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036148522207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology