Provider Demographics
NPI:1104266980
Name:RICHARDSON, KRISTIN J (MD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:J
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SALT CREEK LN
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2936
Mailing Address - Country:US
Mailing Address - Phone:630-286-5500
Mailing Address - Fax:
Practice Address - Street 1:1 SALT CREEK LN
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2936
Practice Address - Country:US
Practice Address - Phone:630-286-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036140041207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology