Healthcare Provider Details

I. General information

NPI: 1053576926
Provider Name (Legal Business Name): TIMOTHY J KRUSER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 JOHN NOLEN DR
MADISON WI
53713-1430
US

IV. Provider business mailing address

680 N LAKE SHORE DR SUITE 1000
CHICAGO IL
60611-4546
US

V. Phone/Fax

Practice location:
  • Phone: 608-251-6868
  • Fax: 608-251-4255
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036.132395
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number53656-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: