Individual
JONATHAN RICHARD KROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
12251 S 80TH AVE STE 1630, PALOS HEIGHTS, IL 60463-1256
(630) 649-8972
Mailing address
12251 S. 80TH AVE, SUITE 1630, PALOS HEIGHTS, IL 60463
(708) 923-5173
(708) 923-5018
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209.014337
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209014337001
—
IL
01
—
F400410704
MEDICARE PTAN
IL
Enumeration date
06/20/2016
Last updated
09/19/2017
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