Provider Demographics
NPI:1366739328
Name:GRDINOVAC, KRISTINE KATHY (MD)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:KATHY
Last Name:GRDINOVAC
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 1:3901 RAINBOW BLVD
Mailing Address - Street 2:MS 2024
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8500
Mailing Address - Country:US
Mailing Address - Phone:913-588-0486
Mailing Address - Fax:913-588-4060
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MS 2024
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-0486
Practice Address - Fax:913-535-2101
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9407713207RE0101X
KS04-37276207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism