MEDICARE: MS. KRISTIN A DOLLING M.D.

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
1	207V00000X	Obstetrics & Gynecology Physician	336-061386	IL

General Provider Information

NPI Number	:	1174557524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTIN A DOLLING M.D.

Provider Business Mailing Address
First Line	:	2740 W FOSTER AVE STE 310
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3547
Country	:	US
Telephone Number	:	773-878-8200
Fax Number	:	773-293-8804

Provider Business Practice Location Address
First Line	:	5346 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2120
Country	:	US
Telephone Number	:	773-293-8880
Fax Number	:	773-293-8843

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	10/30/2020

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