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General NPI Number Information
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NPI Number | 1538489869
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Entity Type | Individual
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Provider Name | KRISTIN W HOUSEKNECHT M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/09/2010
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 614 W MONROE ST
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City | CHICAGO
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State | IL
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Zip | 60661-3654
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Country | US
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Telephone | 312-258-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 1074 W TAYLOR ST UNIT 319
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City | CHICAGO
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State | IL
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Zip | 60607-4336
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Country | US
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Telephone | 813-495-2785
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME108909
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 01077086A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | TRN14997
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number | 036.142542
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License Number State | IL
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