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General NPI Number Information
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NPI Number | 1831195841
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Entity Type | Individual
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Provider Name | TIMOTHY STEPHEN KRUSE DPM
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Gender | Male
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 06/23/2021
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Provider Practice Location Address
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Address Line | 750 N FRANKLIN ST STE 102
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City | CHICAGO
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State | IL
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Zip | 60654-6263
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Country | US
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Telephone | 312-280-7886
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Fax | 312-280-9547
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Provider Business Mailing Address
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Address Line | 750 N FRANKLIN ST STE 102
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City | CHICAGO
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State | IL
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Zip | 60654-6263
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Country | US
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Telephone | 312-280-7886
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Fax | 312-280-9547
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016005211
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 213EP0504X
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Taxonomy Name | Public Medicine Podiatrist
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License Number | 016005211
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 016-005211
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 016-005211
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016005211
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License Number State | IL
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