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NPI Code Detail

MEDICARE: DR. NURIT CRYSTAL M.D

MEDICARE: DR. NURIT CRYSTAL 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
1207Q00000XFamily Medicine Physician036109610IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1036109610OTHERILSTATE LICENSE

General Provider Information

NPI Number : 1457350118
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NURIT CRYSTAL M.D
Provider Business Mailing Address
First Line : 1941 ROHLWING RD
Second Line :
City : ROLLING MEADOWS
State : IL
Zip : 60008-1338
Country : US
Telephone Number : 847-618-0850
Fax Number : 847-618-0852
Provider Business Practice Location Address
First Line : 1941 ROHLWING RD
Second Line :
City : ROLLING MEADOWS
State : IL
Zip : 60008-1338
Country : US
Telephone Number : 847-618-0850
Fax Number : 847-618-0859
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2005
Last Update Date : 04/28/2021

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