Provider Demographics
NPI:1962583427
Name:CRULCICH, JOHN MICHAEL (APN, FNP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MICHAEL
Last Name:CRULCICH
Suffix:
Gender:M
Credentials:APN, FNP
Other - Prefix:MR
Other - First Name:J.
Other - Middle Name:MICHAEL
Other - Last Name:CRULCICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN, FNP
Mailing Address - Street 1:734 S MILLER ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3409
Mailing Address - Country:US
Mailing Address - Phone:312-421-3392
Mailing Address - Fax:
Practice Address - Street 1:333 S STATE ST
Practice Address - Street 2:ROOM 2143
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3900
Practice Address - Country:US
Practice Address - Phone:312-747-9678
Practice Address - Fax:312-747-9420
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-002450(41-19641)363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily