Provider Demographics
NPI:1801501515
Name:ESCOBAR ALVARENGA, KRISTIN CHENILLE (MD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:CHENILLE
Last Name:ESCOBAR ALVARENGA
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 1:3513 W MCLEAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3630
Mailing Address - Country:US
Mailing Address - Phone:832-567-3236
Mailing Address - Fax:
Practice Address - Street 1:3513 W MCLEAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3630
Practice Address - Country:US
Practice Address - Phone:832-567-3236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03613392207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic PathologyGroup - Single Specialty