Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 96002226 | IL |
Y | 213ES0000X | Sports Medicine | 96002226 | IL |
NPI | 1083683486 |
---|---|
Provider Name | Ms. Kristine M Myren |
First Address | Skokie, IL 60077-3692 |
Second Address | Glenview, IL 60025-7645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 08/07/2007 |