Organization
BRYAN M KRUSKOL DO SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN M KRUSKOL DO (DIRECTOR PHYSICIAN)
(815) 899-8080
Entity
Organization
Contact information
Practice address
1675 BETHANY RD, SUITE C, SYCAMORE, IL 60178-3160
(815) 899-8080
(815) 899-8002
Mailing address
1675 BETHANY RD, SUITE C, SYCAMORE, IL 60178-3160
(815) 899-8080
(815) 899-8002
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01932071
BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/09/2006
Last updated
12/31/2007
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