Provider Demographics
NPI:1265509400
Name:CRISOSTOMO, MARIA ISABEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA ISABEL
Middle Name:L
Last Name:CRISOSTOMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ISABEL
Other - Middle Name:L
Other - Last Name:CRISOSTOMO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:850 MADISON ST STE A
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-4463
Mailing Address - Country:US
Mailing Address - Phone:708-613-4140
Mailing Address - Fax:708-434-5641
Practice Address - Street 1:850 MADISON ST STE A
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-4463
Practice Address - Country:US
Practice Address - Phone:708-613-4140
Practice Address - Fax:708-434-5641
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-087956207R00000X, 207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG98821Medicare UPIN