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NPI Code Detail

MEDICARE: KRISTEN HERMANSON DO

MEDICARE: KRISTEN HERMANSON DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician036.156703IL

General Provider Information

NPI Number : 1104320894
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN HERMANSON DO
Provider Business Mailing Address
First Line : 1300 W DEVON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60660-1302
Country : US
Telephone Number : 773-751-7800
Fax Number :
Provider Business Practice Location Address
First Line : 1300 W DEVON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60660-1302
Country : US
Telephone Number : 773-751-7800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2018
Last Update Date : 05/13/2026

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Directions to “ KRISTEN HERMANSON DO” Practice Location

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