Healthcare Provider Details

I. General information

NPI: 1609303254
Provider Name (Legal Business Name): KIERA ANNE KINGSTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6141 N CICERO AVE
CHICAGO IL
60646-4303
US

IV. Provider business mailing address

4901 SEARLE PKWY
SKOKIE IL
60077-5313
US

V. Phone/Fax

Practice location:
  • Phone: 847-866-7846
  • Fax: 773-907-7760
Mailing address:
  • Phone: 847-982-6710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036171386
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number1013290
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number315923
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number125070159
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: