Individual
JOHN FREDRICK KRECKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
520 N 4TH ST, SPRINGFIELD, IL 62702-5238
(217) 545-8000
(217) 747-1351
Mailing address
PO BOX 19670, SPRINGFIELD, IL 62794-9670
(217) 545-8000
(217) 747-1351
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036097934
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036097394
CONTROLLED SUB. LICENSE
IL
01
—
036097934
LICENSE
IL
05
—
036097934
—
IL
01
—
IL2613
MEDICARE GROUP #
—
Enumeration date
09/20/2006
Last updated
03/07/2023
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