MEDICARE: TIMOTHY STEPHEN KRUSE DPM

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	213E00000X	Podiatrist	016005211	IL
2	213EP0504X	Public Medicine Podiatrist	016005211	IL
3	213EP1101X	Primary Podiatric Medicine Podiatrist	016-005211	IL
4	213ES0131X	Foot Surgery Podiatrist	016-005211	IL
5	213ES0103X	Foot & Ankle Surgery Podiatrist	016005211	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00002465026 05	OTHER	IL	UNITED HEALTHCARE
2	316-002321	OTHER	IL	CSR
3	7032671	OTHER	IL	AETNA
4	7072691	OTHER	IL	CIGNA

General Provider Information

NPI Number	:	1831195841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY STEPHEN KRUSE DPM

Provider Business Mailing Address
First Line	:	750 N FRANKLIN ST
Second Line	:	STE 102
City	:	CHICAGO
State	:	IL
Zip	:	60654-6263
Country	:	US
Telephone Number	:	312-280-7886
Fax Number	:	312-280-9547

Provider Business Practice Location Address
First Line	:	750 N FRANKLIN ST
Second Line	:	STE 102
City	:	CHICAGO
State	:	IL
Zip	:	60654-6263
Country	:	US
Telephone Number	:	312-280-7886
Fax Number	:	312-280-9547

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	06/23/2021

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