Healthcare Provider Details

I. General information

NPI: 1669588869
Provider Name (Legal Business Name): JOSEPH JEFFREY KRUG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S 13TH ST
PEKIN IL
61554-4936
US

IV. Provider business mailing address

4301 N STAR WAY
MODESTO CA
95356-9262
US

V. Phone/Fax

Practice location:
  • Phone: 309-347-1151
  • Fax:
Mailing address:
  • Phone: 209-342-2300
  • Fax: 209-524-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number036060195
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: