Provider Demographics
NPI:1477566776
Name:CHARNOND, KIRSTEN S (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:S
Last Name:CHARNOND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:CHARNOND
Other - Last Name:RAVAGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6374 N LINCOLN AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1275
Mailing Address - Country:US
Mailing Address - Phone:773-509-0023
Mailing Address - Fax:773-509-1839
Practice Address - Street 1:6374 N LINCOLN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1275
Practice Address - Country:US
Practice Address - Phone:773-509-0023
Practice Address - Fax:773-509-1839
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361154192080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine