Provider Demographics
NPI:1184885964
Name:WARD, KRISTINA MARIE (MD)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:MARIE
Last Name:WARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KRISTINA
Other - Middle Name:MARIE
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:185 N. MILWAUKEE AVE.
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069
Mailing Address - Country:US
Mailing Address - Phone:847-821-9500
Mailing Address - Fax:847-821-9501
Practice Address - Street 1:185 N. MILWAUKEE AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069
Practice Address - Country:US
Practice Address - Phone:847-821-9500
Practice Address - Fax:847-821-9501
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101249331208000000X
IL036.134696208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics