Provider Demographics
NPI:1104877547
Name:BINGEN, KRISTIN M (PHD)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:M
Last Name:BINGEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC HEMATOLOGY/ONCOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-456-4148
Mailing Address - Fax:414-456-6543
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC HEMATOLOGY/ONCOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-456-4148
Practice Address - Fax:414-456-6543
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2468103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1104877547Medicaid
007906261HOtherHUMANA
WI68086 0777Medicare PIN
007906261HOtherHUMANA
Q02401Medicare UPIN