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NPI Code Detail

MEDICARE: CRYSTAL NARCISSE MD

MEDICARE: CRYSTAL NARCISSE MD
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
1208000000XPediatrics Physician45208KY
2207R00000XInternal Medicine Physician45208KY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2K059330OTHERKYMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336308279
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL NARCISSE MD
Provider Business Mailing Address
First Line : PO BOX 776351
Second Line :
City : CHICAGO
State : IL
Zip : 60677-6351
Country : US
Telephone Number : 502-588-9490
Fax Number : 502-272-5116
Provider Business Practice Location Address
First Line : 213 N HURSTBOURNE PKWY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40222-5139
Country : US
Telephone Number : 502-327-5135
Fax Number : 502-327-9475
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2008
Last Update Date : 11/01/2019

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Directions to “ CRYSTAL NARCISSE MD” Practice Location

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