Provider Demographics
NPI:1699526756
Name:GIDDENS, KRISTINA LAURA (DO)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:LAURA
Last Name:GIDDENS
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 1:2501 WESTOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-5054
Mailing Address - Country:US
Mailing Address - Phone:765-252-7544
Mailing Address - Fax:
Practice Address - Street 1:4220 W 95TH ST STE 210
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2793
Practice Address - Country:US
Practice Address - Phone:312-949-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125083729208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program