1336243815 NPI number — KRISTI N REDLICH MD

Table of content: KRISTI N REDLICH MD (NPI 1336243815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336243815 NPI number — KRISTI N REDLICH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDLICH
Provider First Name:
KRISTI
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EGLAND
Provider Other First Name:
KRISTI
Provider Other Middle Name:
N
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1336243815
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10350 HALIGUS RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTLEY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60142-9545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-338-6600
Provider Business Mailing Address Fax Number:
847-802-7200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10350 HALIGUS RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTLEY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-338-6600
Provider Business Practice Location Address Fax Number:
847-802-7200
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  036115247 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036115247 . This is a "STATE LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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