Healthcare Provider Details

I. General information

NPI: 1720103765
Provider Name (Legal Business Name): KRISTINA L SVENSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TINA L SVENSON M.D.

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 N. OAK PARK AVE
CHICAGO IL
60707-3392
US

IV. Provider business mailing address

PO BOX 209013
DALLAS TX
75320-9013
US

V. Phone/Fax

Practice location:
  • Phone: 773-385-5498
  • Fax:
Mailing address:
  • Phone: 773-385-5498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036079557
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: