MEDICARE: ALEKSANDAR L KRUNIC 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	036-101957	IL
2	207ND0101X	MOHS-Micrographic Surgery Physician	036-101-957	IL

General Provider Information

NPI Number	:	1891721965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEKSANDAR L KRUNIC MD, PHD

Provider Business Mailing Address
First Line	:	3000 N HALSTED ST STE 620
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5196
Country	:	US
Telephone Number	:	773-871-7000
Fax Number	:	737-871-4344

Provider Business Practice Location Address
First Line	:	3000 N HALSTED ST STE 620
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5196
Country	:	US
Telephone Number	:	773-871-7000
Fax Number	:	773-871-4344

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	10/16/2023

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