Provider Demographics
NPI:1871507533
Name:FRANK, CRISTA JOY (DPM)
Entity Type:Individual
Prefix:
First Name:CRISTA
Middle Name:JOY
Last Name:FRANK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 JOHNSTON DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-6411
Mailing Address - Country:US
Mailing Address - Phone:847-780-4873
Mailing Address - Fax:847-780-4873
Practice Address - Street 1:123 JOHNSTON DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-6411
Practice Address - Country:US
Practice Address - Phone:847-780-4873
Practice Address - Fax:847-780-4873
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM00318213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003927Medicaid
309003927Medicare ID - Type Unspecified
RI9003927Medicaid