Healthcare Provider Details

I. General information

NPI: 1598705196
Provider Name (Legal Business Name): KENNETH Q CRUZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W CENTRAL RD
ARLINGTON HEIGHTS IL
60005-2349
US

IV. Provider business mailing address

830 WEST RTE 22 SUITE 50
LAKE ZURICH IL
60047
US

V. Phone/Fax

Practice location:
  • Phone: 800-655-2656
  • Fax: 412-822-7411
Mailing address:
  • Phone: 866-344-0543
  • Fax: 866-344-3934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.100876
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA90441
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA90441
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: