Basic Information
Provider Information
NPI: 1366485740
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LIPSTREUER
FirstName: KRISTEN
MiddleName: E
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 680 N LAKE SHORE DR
Address2:  
City: CHICAGO
State: IL
PostalCode: 606114546
CountryCode: US
TelephoneNumber: 3126956868
FaxNumber:  
Practice Location
Address1: 259 E ERIE ST
Address2:  
City: CHICAGO
State: IL
PostalCode: 606112987
CountryCode: US
TelephoneNumber: 3126956868
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/14/2006
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X036.131725ILY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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