Provider Demographics
NPI:1720103765
Name:SVENSON, KRISTINA L (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:L
Last Name:SVENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:L
Other - Last Name:SVENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 209013
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-9013
Mailing Address - Country:US
Mailing Address - Phone:773-385-5498
Mailing Address - Fax:
Practice Address - Street 1:2211 N. OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-3392
Practice Address - Country:US
Practice Address - Phone:773-385-5498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036079557208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics