Provider Demographics
NPI:1346695509
Name:WARNER, KRISTINA JANEA (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:JANEA
Last Name:WARNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTINA
Other - Middle Name:JANEA
Other - Last Name:WARNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:250 E SUPERIOR ST STE 5-2166
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2914
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 E SUPERIOR ST STE 5-2166
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2914
Practice Address - Country:US
Practice Address - Phone:312-472-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125073309207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology