Provider Demographics
NPI:1316943137
Name:TEODORI, KRISTINE (DO)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:TEODORI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3281
Mailing Address - Country:US
Mailing Address - Phone:219-663-4877
Mailing Address - Fax:219-663-4877
Practice Address - Street 1:300 N MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3281
Practice Address - Country:US
Practice Address - Phone:219-663-4877
Practice Address - Fax:219-663-4877
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2021-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002441207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000721931OtherANTHEM TRADITIONAL
IN200492390Medicaid
IN200492390Medicaid
ININ2007001Medicare UPIN
IN202790KKMedicare PIN