# KSB MEDICAL GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** KSB Center for Diabetes Management
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629046115
- **Authorized official:** MR. KEVIN T MARX (VICE PRESIDENT)
- **Authorized official phone:** (815) 285-5508

## Contact information

- **Practice address:** 215 E 1ST ST, STE 101, DIXON, IL 61021-3166
- **Practice address phone:** (815) 285-5973
- **Practice address fax:** (815) 285-5974
- **Mailing address:** 215 E 1ST ST, STE 101, DIXON, IL 61021-3166
- **Mailing address phone:** (815) 285-5973
- **Mailing address fax:** (815) 285-5974

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/09/2006
- **Last updated:** 08/22/2020