CRYSTALKINETICS, LLC (NPI# 1649448259) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
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 |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
Allopathic & Osteopathic Physicians |
Street Address |
4113 N LAKE DR |
City | SHOREWOOD |
State | WI |
Zip Code | 53211-1720 |
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 |
Find all providers in zip 53211 |
Taxonomy Code | 207RN0300X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
Specialization | Nephrology |
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. |
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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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.