Healthcare Provider Details

I. General information

NPI: 1396982963
Provider Name (Legal Business Name): KRISTINS KIDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2009
Last Update Date: 01/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4733 N DAMEN AVE
CHICAGO IL
60625-1442
US

IV. Provider business mailing address

55 E ERIE ST
CHICAGO IL
60611-2798
US

V. Phone/Fax

Practice location:
  • Phone: 773-537-0020
  • Fax:
Mailing address:
  • Phone: 773-537-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036106744
License Number StateIL

VIII. Authorized Official

Name: DR. DANIEL OROZCO
Title or Position: NEUROLOGIST
Credential: M.D.
Phone: 773-537-0020