Healthcare Provider Details

I. General information

NPI: 1437561446
Provider Name (Legal Business Name): COURTNEY CRIPPS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2014
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

5841 S MARYLAND AVE STE J641
CHICAGO IL
60637-1443
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1000
  • Fax: 773-702-1634
Mailing address:
  • Phone: 773-702-1000
  • Fax: 773-702-1634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number036159879
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: