Provider Demographics
NPI:1457350118
Name:CRYSTAL, NURIT (MD)
Entity type:Individual
Prefix:DR
First Name:NURIT
Middle Name:
Last Name:CRYSTAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 ROHLWING RD
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-1338
Mailing Address - Country:US
Mailing Address - Phone:847-618-0850
Mailing Address - Fax:847-618-0852
Practice Address - Street 1:1941 ROHLWING RD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-1338
Practice Address - Country:US
Practice Address - Phone:847-618-0850
Practice Address - Fax:847-618-0859
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109610207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109610OtherSTATE LICENSE
ILK10996Medicare ID - Type Unspecified
IL732490Medicare PIN
IL036109610OtherSTATE LICENSE
IL976700Medicare ID - Type UnspecifiedGROUP MEDICARE #