Healthcare Provider Details

I. General information

NPI: 1659473247
Provider Name (Legal Business Name): KEVIN MICHAEL CRONIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 NORTH LAKEWOOD ROAD
LAKE IN THE HILLS IL
60156-5945
US

IV. Provider business mailing address

170 NORTH LAKEWOOD ROAD
LAKE IN THE HILLS IL
60156-5945
US

V. Phone/Fax

Practice location:
  • Phone: 224-569-4000
  • Fax: 224-569-4001
Mailing address:
  • Phone: 224-569-4000
  • Fax: 224-569-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-105826
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-105826
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: