Healthcare Provider Details

I. General information

NPI: 1801967633
Provider Name (Legal Business Name): ALEKSANDAR KRUNIC, MD, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N HALSTED ST STE 620
CHICAGO IL
60657-5196
US

IV. Provider business mailing address

3000 N HALSTED ST STE 620
CHICAGO IL
60657-5196
US

V. Phone/Fax

Practice location:
  • Phone: 773-871-7000
  • Fax: 773-907-6336
Mailing address:
  • Phone: 773-871-7000
  • Fax: 773-907-6336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number036101957
License Number StateIL

VIII. Authorized Official

Name: DR. ALEKSANDAR L KRUNIC
Title or Position: PRESIDENT
Credential: MD
Phone: 773-907-8454