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General NPI Number Information
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NPI Number | 1548596711
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Entity Type | Individual
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Provider Name | KRISTIN MICHELLE DAUGHERTY M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 01/22/2013
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Provider Practice Location Address
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Address Line | 1423 CHICAGO RD
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-3400
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Country | US
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Telephone | 708-709-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 121 W CHESTNUT ST 3402
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City | CHICAGO
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State | IL
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Zip | 60610-3175
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Country | US
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Telephone | 304-893-8940
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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 | 146D00000X
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Taxonomy Name | Personal Emergency Response Attendant
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License Number | 57.016186
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License Number State | OH
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