Healthcare Provider Details

I. General information

NPI: 1871401067
Provider Name (Legal Business Name): KRYSTAL MICHAEL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 W 95TH ST STE 106
EVERGREEN PARK IL
60805-2088
US

IV. Provider business mailing address

9407 S AVERS AVE
EVERGREEN PARK IL
60805-2008
US

V. Phone/Fax

Practice location:
  • Phone: 708-264-9012
  • Fax:
Mailing address:
  • Phone: 708-264-9012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA L WRIGHT
Title or Position: PSYCHIATRIC NURSEPRACTITIONER
Credential: PMHNP-BC
Phone: 708-264-9012