MEDICARE: KRISTEN SARDIN

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
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1588223614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN SARDIN

Provider Business Mailing Address
First Line	:	2111 121ST ST
Second Line	:
City	:	BLUE ISLAND
State	:	IL
Zip	:	60406-1201
Country	:	US
Telephone Number	:	773-499-4062
Fax Number	:

Provider Business Practice Location Address
First Line	:	2111 121ST ST
Second Line	:
City	:	BLUE ISLAND
State	:	IL
Zip	:	60406-1201
Country	:	US
Telephone Number	:	773-499-4062
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2019
Last Update Date	:	06/12/2019

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Directions to “ KRISTEN SARDIN ” Practice Location

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