MEDICARE: JENNIFER CROIX MD, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	284898	NY
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207N00000X	Dermatology Physician	036144314	IL

General Provider Information

NPI Number	:	1144596628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CROIX MD, PHD

Provider Business Mailing Address
First Line	:	515 N STATE ST STE 900
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-9104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 N STATE ST STE 900
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-9104
Country	:	US
Telephone Number	:	312-245-9965
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2012
Last Update Date	:	04/02/2024

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