Individual
CRISALE COSAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2100 MADISON AVE, GRANITE CITY, IL 62040-4701
(618) 798-3000
Mailing address
2100 MADISON AVE, GRANITE CITY, IL 62040-4701
(618) 798-3000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036085907
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036085907
—
IL
Enumeration date
02/22/2007
Last updated
07/08/2007
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