Provider Demographics
NPI:1609303254
Name:KINGSTON, KIERA ANNE (MD)
Entity type:Individual
Prefix:
First Name:KIERA
Middle Name:ANNE
Last Name:KINGSTON
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 1:4901 SEARLE PKWY
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-5313
Mailing Address - Country:US
Mailing Address - Phone:847-982-6710
Mailing Address - Fax:
Practice Address - Street 1:6141 N CICERO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4303
Practice Address - Country:US
Practice Address - Phone:847-866-7846
Practice Address - Fax:773-907-7760
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036171386207X00000X
MA1013290207X00000X
NY315923207X00000X
IL125070159207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery