Provider Demographics
NPI:1982642740
Name:TREVINO, KRISTIN M (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:TREVINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:M
Other - Last Name:GRUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1051 W RAND RD # 110
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-2315
Mailing Address - Country:US
Mailing Address - Phone:847-618-9292
Mailing Address - Fax:847-618-9294
Practice Address - Street 1:1051 W RAND RD STE 110
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-2315
Practice Address - Country:US
Practice Address - Phone:847-618-9292
Practice Address - Fax:847-618-9294
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
K50487Medicare PIN
K50488Medicare PIN