CRYSTALKINETICS, LLC


Address: 4113 N Lake Dr, Shorewood, WI 53211-1720
Phone: 4149619361

CRYSTALKINETICS, LLC (NPI# 1649448259) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1649448259
Entity Type Organization
Organization Name CRYSTALKINETICS, LLC
Practice Address 4113 N Lake Dr
Shorewood
WI 53211-1720
Practice Telephone 4149619361
Mailing Telephone 4149619361
Enumeration Date 2008-02-16
Last Update Date 2008-02-16
Authorized Official Name DR. JEFFREY L WIDELL (PRESIDENT)
Authorized Official Telephone 4149619361
Authorized Official Credential MD
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207RN0300X Internal Medicine
Specialization: Nephrology
Allopathic & Osteopathic Physicians

Office Location

Street Address 4113 N LAKE DR
City SHOREWOOD
State WI
Zip Code 53211-1720

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1821602335 Gabriella Caitrin Emanuele Occupational Therapist Harborchase of Shorewood, 1111 E Capitol Drive, Shorewood, WI 53211 2020-09-02
1710527783 Sage Specialty Pharmacy Inc. Pharmacy 4001 N. Oakland Ave, Shorewood, WI 53211 2020-01-08
1861043952 Rosina Bloomingdale Norton Nurse Practitioner 1921 E Harford Ave, Milwaukee, WI 53211 2019-09-20
1528556255 Renee Reckelberg Specialist/Technologist 3409 North Downer Avenue, Pavilion, Suite 350, Milwaukee, WI 53211 2018-04-27
1700325602 Wisconsin Vision, Inc. Optometrist 4163 N Oakland Ave, Shorewood, WI 53211 2017-02-13
1750827556 Daniel Butz M.d., S.c. Plastic Surgery 2350 N Lake Dr Ste 304, Milwaukee, WI 53211 2017-01-17
1528517232 Therese Simonis Speech-Language Pathologist 2390 N Lake Drive, Milwaukee, WI 53211 2016-09-23
1982075701 Katie Michel Specialist/Technologist 3409 N. Downer Ave, Milwaukee, WI 53211 2015-10-20
1255776365 Sarah Elizabeth Brill Social Worker 4433 N Oakland Ave Ste D, Shorewood, WI 53211 2013-05-02
1679814537 Nicole Anne Parulski Physical Therapist 2301 North Lake Dr, Milwaukee, WI 53211 2013-03-01
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Taxonomy Information

Taxonomy Code 207RN0300X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Nephrology

Taxonomy Definition

An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]
- Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine.

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1841823390 Kelby Roholt Internal Medicine 305 E Mahn Ct, Oak Creek, WI 53154-2101 2020-02-12
1477186922 Sydney Kemps Internal Medicine 507 N 17th St, Milwaukee, WI 53233-5495 2020-02-12
1053708511 Rishi Kora Internal Medicine 5650 N Green Bay Ave Ste 210, Glendale, WI 53209-4447 2015-04-22
1841523818 Sana Waheed Internal Medicine 301 S Yellowstone Dr Apt 306, Madison, WI 53705-4378 2009-09-09
1841426798 Wisconsin Vascular Access and Nephrology Internal Medicine 1962 N Prospect Ave # 310, Milwaukee, WI 53202-1414 2009-06-05
1184865099 Zurab Albekioni Internal Medicine 3000 Westhill Dr Ste 108, Wausau, WI 54401-3795 2009-03-23
1104095017 Mark Y Nunag Internal Medicine 2050 Continential Drive, West Bend, WI 53095 2008-02-25
1699975193 Dawn Wolfgram Internal Medicine 5000 W National Ave # Cc-111k, Milwaukee, WI 53295-1000 2007-07-23
1366657710 Deepak Sharma Internal Medicine 7797 W Appletone Ave, Milwaukee, WI 53222 2007-05-11
1497855126 Stephen L Blonsky Internal Medicine S88w12923 Upland Ln, Muskego, WI 53150-7341 2006-09-23
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Competitor

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City SHOREWOOD
Zip Code 53211

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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