Healthcare Provider Details

I. General information

NPI: 1871233346
Provider Name (Legal Business Name): ADAM KRESS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E 2ND ST
SPRING VALLEY IL
61362-1517
US

IV. Provider business mailing address

2148 DONAHUE ST
LA SALLE IL
61301-1106
US

V. Phone/Fax

Practice location:
  • Phone: 815-221-1340
  • Fax:
Mailing address:
  • Phone: 313-580-1364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036176589
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: