Healthcare Provider Details

I. General information

NPI: 1790346682
Provider Name (Legal Business Name): KRISTEN LU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2019
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 E MADISON ST FL 3
SPRINGFIELD IL
62701-1035
US

IV. Provider business mailing address

PO BOX 19642
SPRINGFIELD IL
62794-9642
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8229
  • Fax: 217-545-2275
Mailing address:
  • Phone: 217-545-8229
  • Fax: 217-545-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA12412100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number332806
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number332806
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA12412100
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036169928
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036169928
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: