Provider Demographics
NPI:1780189712
Name:KISTNER, MARGARET BROWN (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:BROWN
Last Name:KISTNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2853 N AVERS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7203
Mailing Address - Country:US
Mailing Address - Phone:314-255-8516
Mailing Address - Fax:
Practice Address - Street 1:680 N LAKE SHORE DR STE 1200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-8702
Practice Address - Country:US
Practice Address - Phone:312-440-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILPENDING207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology