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General NPI Number Information
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NPI Number | 1568841872
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Entity Type | Individual
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Provider Name | KRISTY LEIGH ILGEN DO
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Gender | Female
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 48 SHORT DR
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City | BLAIRSVILLE
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State | PA
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Zip | 15717-8095
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Country | US
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Telephone | 724-235-7793
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Fax | 724-675-8668
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Provider Business Mailing Address
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Address Line | 501 HOWARD AVE SUITE F4
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City | ALTOONA
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State | PA
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Zip | 16601-4810
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Country | US
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Telephone | 814-889-2020
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Fax | 814-889-2213
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS019539
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License Number State | PA
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