Healthcare Provider Details

I. General information

NPI: 1003747627
Provider Name (Legal Business Name): JOSEPH ROBERT KREBS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S PAULINA ST
CHICAGO IL
60612-3806
US

IV. Provider business mailing address

1454 W RANDOLPH ST APT 906
CHICAGO IL
60607-1430
US

V. Phone/Fax

Practice location:
  • Phone: 913-544-6685
  • Fax:
Mailing address:
  • Phone: 913-544-6685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number125.087595
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: