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Organization
CRYSTALKINETICS, LLC
Active
Organization
CRYSTALKINETICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY L WIDELL MD (PRESIDENT)
(414) 961-9361
Entity
Organization
Contact information
Practice address
4113 N LAKE DR, SHOREWOOD, WI 53211-1720
(414) 961-9361
Mailing address
4113 N LAKE DR, SHOREWOOD, WI 53211-1720
(414) 961-9361
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Enumeration date
02/16/2008
Last updated
02/16/2008
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