Individual
DOUGLAS ANTHONY KRUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 257-6220
Mailing address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 257-6220
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-098255
IL
208M00000X
Hospitalist Physician
036098255
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01427671
IL BLUESHIELD
IL
05
—
036-098255
—
IL
01
—
100888
GROUP HEALTH PLAN
IL
Enumeration date
08/21/2006
Last updated
03/19/2021
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