MEDICARE: KREG THERAPEUTICS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)		IL

General Provider Information

NPI Number	:	1477744985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KREG THERAPEUTICS, INC.

Provider Business Mailing Address
First Line	:	1300 WASHINGTON RD
Second Line	:
City	:	WASHINGTON
State	:	IL
Zip	:	61571-2368
Country	:	US
Telephone Number	:	312-829-8904
Fax Number	:	312-829-8909

Provider Business Practice Location Address
First Line	:	1300 WASHINGTON ROAD
Second Line	:
City	:	WASHINGTON
State	:	IL
Zip	:	61571-2368
Country	:	US
Telephone Number	:	312-829-8909
Fax Number	:	312-829-8909

Authorized Official
Title or Position	:	MEDICARE BILLER
Name	:	MARIA I MAYORGA
Credential	:
Telephone Number	:	312-829-8904

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	08/08/2007

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