MEDICARE: DR. CRAIG H GERSTEIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	036-104297	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	180042637	OTHER	IL	RAILROAD MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1627829	OTHER	IL	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1083712681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG H GERSTEIN M.D.

Provider Business Mailing Address
First Line	:	3042 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3729
Country	:	US
Telephone Number	:	773-973-3223
Fax Number	:	773-973-1119

Provider Business Practice Location Address
First Line	:	3042 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3729
Country	:	US
Telephone Number	:	773-973-3223
Fax Number	:	773-973-1119

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	12/28/2021

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