Provider Demographics
NPI:1528121621
Name:NIEDNER, KRISTEN (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:NIEDNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:WAICOSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:33 W HURON ST
Mailing Address - Street 2:#310
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3753
Mailing Address - Country:US
Mailing Address - Phone:312-642-1301
Mailing Address - Fax:
Practice Address - Street 1:800 W CENTRAL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2349
Practice Address - Country:US
Practice Address - Phone:847-618-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG96425Medicare UPIN