Healthcare Provider Details

I. General information

NPI: 1538126396
Provider Name (Legal Business Name): DANIEL M. KRUSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S MAPLE AVE
OAK PARK IL
60304-1022
US

IV. Provider business mailing address

PO BOX 7398
WESTCHESTER IL
60154-7398
US

V. Phone/Fax

Practice location:
  • Phone: 847-405-0068
  • Fax: 847-940-9568
Mailing address:
  • Phone: 847-405-0068
  • Fax: 847-940-9568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: