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NPI Code Detail

MEDICARE: MS. KRISTINE M MYREN ATC

MEDICARE: MS. KRISTINE M MYREN ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12081S0010XSports Medicine (Physical Medicine & Rehabilitation) Physician96002226IL

General Provider Information

NPI Number : 1083683486
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KRISTINE M MYREN ATC
Provider Business Mailing Address
First Line : 8056 LINCOLN AVE
Second Line :
City : SKOKIE
State : IL
Zip : 60077-3692
Country : US
Telephone Number : 605-421-5003
Fax Number :
Provider Business Practice Location Address
First Line : 2401 RAVINE WAY
Second Line :
City : GLENVIEW
State : IL
Zip : 60025-7645
Country : US
Telephone Number : 847-724-4791
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2006
Last Update Date : 07/08/2007

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