Healthcare Provider Details

I. General information

NPI: 1083712681
Provider Name (Legal Business Name): CRAIG H GERSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3042 W PETERSON AVE
CHICAGO IL
60659-3729
US

IV. Provider business mailing address

3042 W PETERSON AVE
CHICAGO IL
60659-3729
US

V. Phone/Fax

Practice location:
  • Phone: 773-973-3223
  • Fax: 773-973-1119
Mailing address:
  • Phone: 773-973-3223
  • Fax: 773-973-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036-104297
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: