Healthcare Provider Details

I. General information

NPI: 1841256492
Provider Name (Legal Business Name): ROSEANNE KRINSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 W 203RD ST
OLYMPIA FIELDS IL
60461-1183
US

IV. Provider business mailing address

1040 SIERRA DRIVE SUITE 400
GREENWOOD IN
46143-7241
US

V. Phone/Fax

Practice location:
  • Phone: 708-679-2257
  • Fax: 708-709-6353
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-8319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036060016
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: