Healthcare Provider Details

I. General information

NPI: 1588964357
Provider Name (Legal Business Name): KRYSTYNA GAL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16001 108TH AVE
ORLAND PARK IL
60467-8788
US

IV. Provider business mailing address

16001 108TH AVE
ORLAND PARK IL
60467-8788
US

V. Phone/Fax

Practice location:
  • Phone: 708-460-0007
  • Fax:
Mailing address:
  • Phone: 708-460-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number036.132226
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOT012634
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: