Active NPI
Kristine Kay Bordenave, M.D.
- Internal Medicine Physician
- Chicago, IL
National Provider Identifier
1811009368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 95-15
- Practice address
- 5841 S Maryland Ave
MC 5031
Chicago, IL 60637-1447 - Phone
- (773) 702-1000
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 95-15 | NM | Primary |
Addresses
Primary practice location
5841 S Maryland Ave
MC 5031
Chicago, IL 60637-1447
Mailing address
4272 N Marine Dr
Chicago, IL 60613-1710
Phone (312) 520-6657
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95-15 | NM | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Primary Care and Preventive Services, PC | Internal Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Internal Medicine Physician
- Albuquerque, NM
- NPI 1558301903
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1811009368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4272 N MARINE DR",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606131710",
"telephone_number": "312-520-6657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5841 S MARYLAND AVE",
"address_2": "MC 5031",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606371447",
"telephone_number": "773-702-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORDENAVE",
"first_name": "KRISTINE",
"middle_name": "KAY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NM",
"license": "95-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.