MEDICARE: DR. KENNETH A KREBS D.M.D.

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	122300000X	Dentist	19-013265	IL
2	1223P0300X	Periodontics	21-000664	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21-000664	OTHER	IL	SPECIALTY LICENSE
2	19-013265	OTHER	IL	DENTAL LICENSE

General Provider Information

NPI Number	:	1629070743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH A KREBS D.M.D.

Provider Business Mailing Address
First Line	:	30 N MICHIGAN AVE
Second Line	:	STE 822
City	:	CHICAGO
State	:	IL
Zip	:	60602-3805
Country	:	US
Telephone Number	:	312-332-3937
Fax Number	:	312-332-3929

Provider Business Practice Location Address
First Line	:	30 N MICHIGAN AVE
Second Line	:	STE 822
City	:	CHICAGO
State	:	IL
Zip	:	60602-3805
Country	:	US
Telephone Number	:	312-332-3937
Fax Number	:	312-332-3929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	09/11/2025

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