Healthcare Provider Details

I. General information

NPI: 1013102334
Provider Name (Legal Business Name): KREG THERAPEUTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11040 LIN VALLE DR SUITE E
SAINT LOUIS MO
63123-7210
US

IV. Provider business mailing address

2240 W WALNUT ST
CHICAGO IL
60612-2218
US

V. Phone/Fax

Practice location:
  • Phone: 312-829-8909
  • Fax: 312-829-8909
Mailing address:
  • Phone: 312-829-8904
  • Fax: 312-829-8909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MARIA I MAYORGA
Title or Position: MEDICARE BILLER
Credential:
Phone: 312-829-8909