Individual
DR. JEREMY L KROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
8600 N STATE ROUTE 91, SUITE 250, PEORIA, IL 61615-9541
(309) 692-5393
(309) 692-2538
Mailing address
8600 N STATE ROUTE 91, SUITE 250, PEORIA, IL 61615-9541
(309) 692-5393
(309) 692-2538
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036093120
IL
207LP2900X
Pain Medicine (Anesthesiology) Physician
036093120
IL
207Q00000X
Family Medicine Physician
036093120
IL
Other
Enumeration date
10/11/2005
Last updated
08/03/2010
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