Healthcare Provider Details

I. General information

NPI: 1457350118
Provider Name (Legal Business Name): NURIT CRYSTAL M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 ROHLWING RD
ROLLING MEADOWS IL
60008-1338
US

IV. Provider business mailing address

1941 ROHLWING RD
ROLLING MEADOWS IL
60008-1338
US

V. Phone/Fax

Practice location:
  • Phone: 847-618-0850
  • Fax: 847-618-0859
Mailing address:
  • Phone: 847-618-0850
  • Fax: 847-618-0852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036109610
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: