Healthcare Provider Details

I. General information

NPI: 1659689040
Provider Name (Legal Business Name): KRISTIN P HOGE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN P O'BRIEN PA-C

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W LAKE ST
ADDISON IL
60101-2586
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 630-527-3645
  • Fax:
Mailing address:
  • Phone: 847-570-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.003875
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierF400211024
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerMEDICARE PTAN
# 2
Identifier1633878
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBCBS PPO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: