Provider Demographics
NPI:1922282748
Name:SOPALA, KRISTIN MARIE
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:SOPALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 N WOOD ST
Mailing Address - Street 2:104
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5022
Mailing Address - Country:US
Mailing Address - Phone:312-829-4007
Mailing Address - Fax:312-829-4055
Practice Address - Street 1:835 N WOOD ST
Practice Address - Street 2:104
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5022
Practice Address - Country:US
Practice Address - Phone:630-677-2698
Practice Address - Fax:312-327-9984
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies