Provider Demographics
NPI:1801967633
Name:ALEKSANDAR KRUNIC, MD, SC
Entity type:Organization
Organization Name:ALEKSANDAR KRUNIC, MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEKSANDAR
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRUNIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-907-8454
Mailing Address - Street 1:3000 N HALSTED ST STE 620
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5196
Mailing Address - Country:US
Mailing Address - Phone:773-871-7000
Mailing Address - Fax:773-907-6336
Practice Address - Street 1:3000 N HALSTED ST STE 620
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5196
Practice Address - Country:US
Practice Address - Phone:773-871-7000
Practice Address - Fax:773-907-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101957207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG82448Medicare UPIN
ILL96959Medicare ID - Type Unspecified