Healthcare Provider Details

I. General information

NPI: 1528044997
Provider Name (Legal Business Name): BENJAMIN D. KRUMSTOK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 PARK ST SUITE 101
NAPERVILLE IL
60563-2688
US

IV. Provider business mailing address

1730 PARK ST SUITE 101
NAPERVILLE IL
60563-2688
US

V. Phone/Fax

Practice location:
  • Phone: 630-718-0200
  • Fax: 630-718-0900
Mailing address:
  • Phone: 630-718-0200
  • Fax: 630-718-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: