MEDICARE: PIYANAN KRASNOV NP

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	363LG0600X	Gerontology Nurse Practitioner	209.030100	IL
2	363L00000X	Nurse Practitioner	209-030100	IL

General Provider Information

NPI Number	:	1972351989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PIYANAN KRASNOV NP

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1293
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 EAST 93RD STREET SUITE 115
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-4038
Country	:	US
Telephone Number	:	708-636-7575
Fax Number	:	708-636-6193

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

Provider Enumeration Date	:	05/07/2024
Last Update Date	:	05/05/2025

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