Healthcare Provider Details

I. General information

NPI: 1902898836
Provider Name (Legal Business Name): JANICE MARIE KRAKORA-LOOBY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 E BELVIDERE RD SUITE 315
GRAYSLAKE IL
60030-2012
US

IV. Provider business mailing address

1475 E BELVIDERE RD SUITE 315
GRAYSLAKE IL
60030-2012
US

V. Phone/Fax

Practice location:
  • Phone: 847-548-8777
  • Fax: 847-548-8899
Mailing address:
  • Phone: 847-548-8777
  • Fax: 847-548-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: