Healthcare Provider Details

I. General information

NPI: 1427016856
Provider Name (Legal Business Name): CHRISTAL L WEST M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 CRAWFORD AVE
OLYMPIA FIELDS IL
60461-1010
US

IV. Provider business mailing address

1040 SIERRA DR SUITE 400
GREENWOOD IN
46143-7240
US

V. Phone/Fax

Practice location:
  • Phone: 708-679-2160
  • Fax: 708-679-2161
Mailing address:
  • Phone: 317-528-4253
  • Fax: 317-865-8319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036085122
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: