Provider Demographics
NPI:1568841872
Name:ILGEN, KRISTY LEIGH (DO)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:LEIGH
Last Name:ILGEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:501 HOWARD AVE
Mailing Address - Street 2:SUITE F4
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4810
Mailing Address - Country:US
Mailing Address - Phone:814-889-2020
Mailing Address - Fax:814-889-2213
Practice Address - Street 1:501 HOWARD AVE
Practice Address - Street 2:SUITE F2
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4810
Practice Address - Country:US
Practice Address - Phone:814-889-2701
Practice Address - Fax:814-889-7864
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2018-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS019539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine