MEDICARE: DR. DJAMILIA EMILBEKOVNA KRYUKOV 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	207VH0002X	Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician	4301087775	MI
2	207V00000X	Obstetrics & Gynecology Physician	036126711	IL

General Provider Information

NPI Number	:	1588873756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DJAMILIA EMILBEKOVNA KRYUKOV M.D.

Provider Business Mailing Address
First Line	:	1555 BARRINGTON RD STE 425
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-1065
Country	:	US
Telephone Number	:	847-755-1111
Fax Number	:	847-755-1166

Provider Business Practice Location Address
First Line	:	1555 BARRINGTON RD STE 425
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-1065
Country	:	US
Telephone Number	:	847-755-1111
Fax Number	:	847-755-1166

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/21/2022

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