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NPI Code Detail

MEDICARE: DR. JEREMY L KROCK DO

MEDICARE: DR. JEREMY L KROCK DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician036093120IL
2207LP2900XPain Medicine (Anesthesiology) Physician036093120IL
3207Q00000XFamily Medicine Physician036093120IL

General Provider Information

NPI Number : 1073501359
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEREMY L KROCK DO
Provider Business Mailing Address
First Line : 8600 N STATE ROUTE 91
Second Line : SUITE 250
City : PEORIA
State : IL
Zip : 61615-9541
Country : US
Telephone Number : 309-692-5393
Fax Number : 309-692-2538
Provider Business Practice Location Address
First Line : 8600 N STATE ROUTE 91
Second Line : SUITE 250
City : PEORIA
State : IL
Zip : 61615-9541
Country : US
Telephone Number : 309-692-5393
Fax Number : 309-692-2538
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2005
Last Update Date : 08/03/2010

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Directions to “ DR. JEREMY L KROCK DO” Practice Location

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