Healthcare Provider Details

I. General information

NPI: 1740293364
Provider Name (Legal Business Name): CRYSTAL D. CASH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 11/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E 51ST ST
CHICAGO IL
60615-2400
US

IV. Provider business mailing address

1900 W POLK ST SUITE 1335
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-572-2673
  • Fax: 312-572-2669
Mailing address:
  • Phone: 312-864-3925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-076540
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: