MEDICARE: KRITIKAL KARE LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1649913658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRITIKAL KARE LLC

Provider Business Mailing Address
First Line	:	4147 CALLERY RD
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-5006
Country	:	US
Telephone Number	:	630-226-9191
Fax Number	:	630-385-6730

Provider Business Practice Location Address
First Line	:	4147 CALLERY RD
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-5006
Country	:	US
Telephone Number	:	630-226-9191
Fax Number	:	630-385-6730

Authorized Official
Title or Position	:	NURSE PRATCTITIONER
Name	:	JOSEPH MALCOLM
Credential	:	NP
Telephone Number	:	630-216-9191

Provider Enumeration Date	:	04/18/2022
Last Update Date	:	04/18/2022

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