Provider Demographics
NPI:1174525356
Name:HESS, KRISTINE A (MD)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:A
Last Name:HESS
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 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:866-630-9882
Mailing Address - Fax:920-682-5810
Practice Address - Street 1:330 N WABASH AVE
Practice Address - Street 2:#360
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2696
Practice Address - Country:US
Practice Address - Phone:765-664-3292
Practice Address - Fax:765-662-7560
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031254207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100348180AMedicaid
IN296140AMedicare PIN
INE05327Medicare UPIN
IN000000091467OtherBLUE CROSS/BLUE SHIELD