Provider Demographics
NPI:1083712681
Name:GERSTEIN, CRAIG H (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:H
Last Name:GERSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3042 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3729
Mailing Address - Country:US
Mailing Address - Phone:773-973-3223
Mailing Address - Fax:773-973-1119
Practice Address - Street 1:3042 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3729
Practice Address - Country:US
Practice Address - Phone:773-973-3223
Practice Address - Fax:773-973-1119
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-104297207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036104297-1Medicaid
IL180042637OtherRAILROAD MEDICARE NUMBER
IL1627829OtherBCBS PROVIDER NUMBER