Provider Demographics
NPI:1720491590
Name:WESSEL, KRISTIN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:MARIE
Last Name:WESSEL
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 1:5721 S MARYLAND AVE
Mailing Address - Street 2:MC 8016, K155
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1425
Mailing Address - Country:US
Mailing Address - Phone:773-702-7553
Mailing Address - Fax:773-834-0748
Practice Address - Street 1:5721 S MARYLAND AVE
Practice Address - Street 2:MC 8016, K155
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1425
Practice Address - Country:US
Practice Address - Phone:773-702-7553
Practice Address - Fax:773-834-0748
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program