MEDICARE: JOEL L KRAGT 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	207Q00000X	Family Medicine Physician	036-085227	IL
2	207Q00000X	Family Medicine Physician	036085227	IL

General Provider Information

NPI Number	:	1891777850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL L KRAGT M.D

Provider Business Mailing Address
First Line	:	1661 FEEHANVILLE DR STE 120
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-6017
Country	:	US
Telephone Number	:	708-280-9109
Fax Number	:	847-305-8601

Provider Business Practice Location Address
First Line	:	1661 FEEHANVILLE DR STE 120
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-6017
Country	:	US
Telephone Number	:	847-305-8600
Fax Number	:	847-305-8601

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	12/18/2021

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