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NPI Code Detail

MEDICARE: KRISTIN KEGLOVITZ BAKER P.A.-C

MEDICARE:   KRISTIN KEGLOVITZ BAKER  P.A.-C
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
1363AM0700XMedical Physician Assistant085002665IL

General Provider Information

NPI Number : 1235154097
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN KEGLOVITZ BAKER P.A.-C
Provider Business Mailing Address
First Line : 1730 W FARRAGUT AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-2012
Country : US
Telephone Number : 773-972-0724
Fax Number : 773-388-8936
Provider Business Practice Location Address
First Line : 4025 N SHERIDAN RD
Second Line :
City : CHICAGO
State : IL
Zip : 60613-2010
Country : US
Telephone Number : 773-388-8870
Fax Number : 773-388-8936
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2006
Last Update Date : 01/25/2018

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Directions to “ KRISTIN KEGLOVITZ BAKER P.A.-C” Practice Location

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