Provider Demographics
NPI:1306236310
Name:TRUNCALE, KRISTIN MARIE (DPM)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:MARIE
Last Name:TRUNCALE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:MARIE
Other - Last Name:SHERRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1710 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2125
Mailing Address - Country:US
Mailing Address - Phone:847-406-9053
Mailing Address - Fax:
Practice Address - Street 1:1710 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2125
Practice Address - Country:US
Practice Address - Phone:847-406-9053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005591213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist