Healthcare Provider Details

I. General information

NPI: 1215029582
Provider Name (Legal Business Name): JEAN M. KRIZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5666 E STATE ST
ROCKFORD IL
61108-2425
US

IV. Provider business mailing address

5666 E STATE ST
ROCKFORD IL
61108-2425
US

V. Phone/Fax

Practice location:
  • Phone: 815-226-2000
  • Fax:
Mailing address:
  • Phone: 815-226-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number036098334
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: