Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036135316 | IL |
N | 208600000X | Surgeon | 036135316 | IL |
Y | 208C00000X | Colorectal Surgeon | 036135316 | IL |
NPI | 1013203660 |
---|---|
Provider Name | Monika A. Krezalek |
First Address | Highland Park, IL 60035-2558 |
Second Address | Highland Park, IL 60035-2558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2011 |
Last Update Date | 07/10/2019 |