Provider Demographics
NPI:1770572984
Name:JACKMAN, KRISTINE R (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:R
Last Name:JACKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:27790 W HIGHWAY 22
Mailing Address - Street 2:SUITE 37
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2340
Mailing Address - Country:US
Mailing Address - Phone:847-382-4406
Mailing Address - Fax:847-382-7098
Practice Address - Street 1:27790 W HIGHWAY 22
Practice Address - Street 2:SUITE 37
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2340
Practice Address - Country:US
Practice Address - Phone:847-382-4406
Practice Address - Fax:847-382-7098
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-091317207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK06560Medicare PIN
ILG13874Medicare UPIN