=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659908879
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARTIS CHRISTIN KISSEIH MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2020
-----------------------------------------------------
Last Update Date | 02/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 HENRY LUCKOW LN
-----------------------------------------------------
City | BELVIDERE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61008-1702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 779-696-8650
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 265 TERRABROOK WAY
-----------------------------------------------------
City | HAMPSHIRE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60140-1205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-504-4470
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 036165290
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------