Provider Demographics
NPI:1902892805
Name:WURZBURGER, KRISTIN A (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:A
Last Name:WURZBURGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 NW 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:IL
Mailing Address - Zip Code:61231
Mailing Address - Country:US
Mailing Address - Phone:309-582-9450
Mailing Address - Fax:309-582-9479
Practice Address - Street 1:1007 NW 3RD STREET
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:IL
Practice Address - Zip Code:61231
Practice Address - Country:US
Practice Address - Phone:309-582-3789
Practice Address - Fax:309-582-3735
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092344207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371352599001Medicaid
IL0006632002OtherBCBS OF IL
IL371352599001Medicaid
IL0006632002OtherBCBS OF IL
ILL88526Medicare ID - Type UnspecifiedER