Healthcare Provider Details

I. General information

NPI: 1821596164
Provider Name (Legal Business Name): ADAM NICOLAS KRUSE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18901 LAKE SHORE BLVD
EUCLID OH
44119-1078
US

IV. Provider business mailing address

21013 KENMARE DR
SHOREWOOD IL
60404-6099
US

V. Phone/Fax

Practice location:
  • Phone: 216-576-8594
  • Fax:
Mailing address:
  • Phone: 815-529-1622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: