Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036-094418 | IL |
N | 207X00000X | Orthopaedic Surgeon | 35-07-6634-K | OH |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036-094418 | IL |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 235194 | MA |
NPI | 1174790463 |
---|---|
Provider Name | Dr. James Anthony Krcik |
First Address | Crystal Lake, IL 60014-6248 |
Second Address | Crystal Lake, IL 60014-6248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2008 |
Last Update Date | 17/03/2018 |