Provider Demographics
NPI:1700097094
Name:WADYAL, CRYSTAL JONES (MD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:JONES
Last Name:WADYAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:ELISABETH
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:600 W LAKE COOK RD STE 120
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-2085
Mailing Address - Country:US
Mailing Address - Phone:847-808-8884
Mailing Address - Fax:
Practice Address - Street 1:600 W LAKE COOK RD STE 120
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-2085
Practice Address - Country:US
Practice Address - Phone:847-808-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036135050207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1509868Medicaid
LA50986Medicaid
LA1509868Medicaid