Individual
KRISTIN M DERUNGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
17495 LA GRANGE RD, TINLEY PARK, IL 60487-7581
(708) 226-7000
(708) 226-7174
Mailing address
17495 LA GRANGE RD, TINLEY PARK, IL 60487-7581
(708) 226-7000
(708) 226-7174
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085005320
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F400191117
LOCALITY 16
IL
01
—
F400191119
LOCALITY 15
IL
01
—
P01445054
RRMC
IL
Enumeration date
12/31/2014
Last updated
11/13/2015
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