Provider Demographics
NPI:1104927599
Name:HORNICK, KRISTIE (DO)
Entity type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:
Last Name:HORNICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 NORTH COVE BLVD, 3RD FLOOR
Mailing Address - Street 2:PO BOX 12498
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-0098
Mailing Address - Country:US
Mailing Address - Phone:419-291-4225
Mailing Address - Fax:419-479-6193
Practice Address - Street 1:2142 N COVE BLVD
Practice Address - Street 2:THE TOLEDO CHILDRENS HOSPITAL
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:419-291-4225
Practice Address - Fax:419-479-6193
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0088012080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1104927599Medicaid
OH2676242Medicaid
7062846OtherAETNA
10256OtherPARAMOUNT