Healthcare Provider Details

I. General information

NPI: 1265458582
Provider Name (Legal Business Name): KRISTINE G WILLIAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 04/18/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 N OUTER 40 RD STE 310
CHESTERFIELD MO
63017-5941
US

IV. Provider business mailing address

PO BOX 7412029
CHICAGO IL
60674-2029
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6400
  • Fax: 314-454-6401
Mailing address:
  • Phone: 314-454-6400
  • Fax: 314-454-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number106403
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: