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Individual

KRISTINE M LARSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PAC

Contact information

Practice address
3800 HIGHLAND AVE STE 105, DOWNERS GROVE, IL 60515-1558
(630) 574-8222
(630) 574-8225
Mailing address
3800 HIGHLAND AVE STE 105, DOWNERS GROVE, IL 60515-1558
(630) 574-8222
(630) 574-8225

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
085.000355
IL
363A00000X
Physician Assistant
Primary
085.000355
IL
363AM0700X
Medical Physician Assistant
085000355
IL
363AS0400X
Surgical Physician Assistant
085000355
IL

Other

Enumeration date
01/04/2006
Last updated
12/07/2021
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