Provider Demographics
NPI:1356640536
Name:ROSEWELL, KRYSTAL AMY (DO)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:AMY
Last Name:ROSEWELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:AMY
Other - Last Name:BALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2500 W. HIGGINS RD.
Mailing Address - Street 2:SUITE 440
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169
Mailing Address - Country:US
Mailing Address - Phone:847-839-0400
Mailing Address - Fax:847-839-0800
Practice Address - Street 1:2500 W. HIGGINS RD.
Practice Address - Street 2:SUITE 440
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169
Practice Address - Country:US
Practice Address - Phone:847-839-0400
Practice Address - Fax:847-839-0800
Is Sole Proprietor?:No
Enumeration Date:2011-03-27
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.059749208000000X
IL036.136458208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics