Provider Demographics
NPI:1841256492
Name:KRINSKI, ROSEANNE (MD)
Entity type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:
Last Name:KRINSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SIERRA DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7241
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-8319
Practice Address - Street 1:3900 W 203RD ST
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1183
Practice Address - Country:US
Practice Address - Phone:708-679-2257
Practice Address - Fax:708-709-6353
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036060016208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036060016Medicaid
D15296Medicare UPIN
IL036060016Medicaid
ILL95561Medicare ID - Type UnspecifiedFEE SCHEDULE LOCALITY 16