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NPI Code Detail

MEDICARE: KELLEY A KRUG PA C

MEDICARE: KELLEY A KRUG PA C
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
1363A00000XPhysician AssistantIL

General Provider Information

NPI Number : 1821082751
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLEY A KRUG PA C
Provider Business Mailing Address
First Line : 3375 N SEMINARY ST
Second Line :
City : GALESBURG
State : IL
Zip : 61401-1251
Country : US
Telephone Number : 309-343-5114
Fax Number :
Provider Business Practice Location Address
First Line : 3375 N SEMINARY ST
Second Line :
City : GALESBURG
State : IL
Zip : 61401-1251
Country : US
Telephone Number : 309-343-5114
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2005
Last Update Date : 07/08/2007

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Directions to “ KELLEY A KRUG PA C” Practice Location

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