Provider Demographics
NPI:1063485738
Name:KRUM, SANDY A (ATC/L)
Entity Type:Individual
Prefix:MR
First Name:SANDY
Middle Name:A
Last Name:KRUM
Suffix:
Gender:M
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1278 N MILWAUKEE AVE
Mailing Address - Street 2:NUMBER 2W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2289
Mailing Address - Country:US
Mailing Address - Phone:773-308-5700
Mailing Address - Fax:
Practice Address - Street 1:1278 N MILWAUKEE AVE
Practice Address - Street 2:NUMBER 2W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2289
Practice Address - Country:US
Practice Address - Phone:773-308-5700
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor