Healthcare Provider Details

I. General information

NPI: 1558517789
Provider Name (Legal Business Name): KRISTEN E DONIGAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24600 W 127TH ST BUILDING B, SUITE 100
PLAINFIELD IL
60585-9507
US

IV. Provider business mailing address

500 N MICHIGAN AVE STE 2100
CHICAGO IL
60611-3773
US

V. Phone/Fax

Practice location:
  • Phone: 815-731-9000
  • Fax: 815-731-9001
Mailing address:
  • Phone: 312-276-1212
  • Fax: 312-276-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036128239
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: