Provider Demographics
NPI:1255346086
Name:KIRSCHNER, KRISTI (MD)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:KIRSCHNER
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 1:1401 S CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1858
Mailing Address - Country:US
Mailing Address - Phone:773-565-3025
Mailing Address - Fax:773-257-1789
Practice Address - Street 1:1401 S CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1858
Practice Address - Country:US
Practice Address - Phone:773-565-3025
Practice Address - Fax:773-257-1789
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-078182208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036078182Medicaid
IL250011910OtherRAILROAD MEDICARE
IL250011911OtherRAILROAD MEDICARE
ILL77478Medicare PIN
ILL12546Medicare PIN
ILL77477Medicare PIN
IL250011910OtherRAILROAD MEDICARE