Provider Demographics
NPI:1740299288
Name:LUNDBLAD, KRISTIN L (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:L
Last Name:LUNDBLAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:101 S. WASHINGTON
Mailing Address - Street 2:SUITE 122
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068
Mailing Address - Country:US
Mailing Address - Phone:847-692-6628
Mailing Address - Fax:847-692-6891
Practice Address - Street 1:101 S. WASHINGTON
Practice Address - Street 2:SUITE 122
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068
Practice Address - Country:US
Practice Address - Phone:847-692-6628
Practice Address - Fax:847-692-6891
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-105500208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH61939Medicare UPIN