Healthcare Provider Details

I. General information

NPI: 1790040988
Provider Name (Legal Business Name): DEAN KRISTL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 AUSTIN ST EAST TWR STE 563
EVANSTON IL
60202-3439
US

IV. Provider business mailing address

800 AUSTIN ST EAST TWR STE 563
EVANSTON IL
60202-3439
US

V. Phone/Fax

Practice location:
  • Phone: 847-869-0522
  • Fax:
Mailing address:
  • Phone: 847-869-0522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036171558
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301101331
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number036171558
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number4301101331
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number036171558
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number4301101331
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: