Individual
SEAN A CHRYSTAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
24 JOLIET ST, DYER, IN 46311-1705
(219) 852-1524
(219) 933-2288
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
02003500A
IN
207R00000X
Internal Medicine Physician
02003500A
IN
208M00000X
Hospitalist Physician
Primary
02003500A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02003500A
LICENSE
IN
01
—
036-117518
LICENSE
IL
05
—
036117518 - CODE 4
—
IN
05
—
200944290
—
IN
Enumeration date
06/07/2007
Last updated
04/18/2025
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