Healthcare Provider Details

I. General information

NPI: 1174525356
Provider Name (Legal Business Name): KRISTINE A HESS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N WABASH AVE #360
MARION IN
46952-2696
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 765-664-3292
  • Fax: 765-662-7560
Mailing address:
  • Phone: 866-630-9882
  • Fax: 920-682-5810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number01031254
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: