Provider Demographics
NPI:1568566560
Name:KRUMBEIN, ELIEZER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIEZER
Middle Name:
Last Name:KRUMBEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1866 SHERIDAN RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60038-2546
Mailing Address - Country:US
Mailing Address - Phone:847-432-6465
Mailing Address - Fax:847-432-5389
Practice Address - Street 1:1866 SHERIDAN RD
Practice Address - Street 2:SUITE 320
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60038-2546
Practice Address - Country:US
Practice Address - Phone:847-432-6465
Practice Address - Fax:847-432-5389
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71-941103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
04915060OtherBCBS
L008279OtherCHAMPUS
0491506012OtherBCBS
11374180OtherAETNA
1106006OtherMAGELLAN
IL63J610Medicare ID - Type Unspecified
0491506012OtherBCBS