Provider Demographics
NPI:1881601110
Name:PEPPERELL, KRISTOFFER (MD)
Entity type:Individual
Prefix:
First Name:KRISTOFFER
Middle Name:
Last Name:PEPPERELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 HILLCREST RD
Mailing Address - Street 2:#180
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-5418
Mailing Address - Country:US
Mailing Address - Phone:214-619-5410
Mailing Address - Fax:
Practice Address - Street 1:4500 HILLCREST RD
Practice Address - Street 2:#180
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5418
Practice Address - Country:US
Practice Address - Phone:214-619-5410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111333207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL472311OtherHEALTHLINK
ILP00144761OtherRAILROAD MEDICARE
IL7215059OtherBCBS PPO
IL0361113331Medicaid
ILIL01S6OtherJOHN DEERE
IL097842OtherHEALTH ALLIANCE
ILK10341Medicare ID - Type Unspecified
ILH96067Medicare UPIN