Individual
BRYAN M KRUSKOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1850 GATEWAY DR STE 201, SYCAMORE, IL 60178-3192
(815) 766-7021
(815) 758-5690
Mailing address
1850 GATEWAY DR STE 201, SYCAMORE, IL 60178-3192
(815) 766-7021
(815) 758-5690
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036102450
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01932073
BLUE CROSS BLUE SHIELD
IL
05
—
036102450
—
IL
Enumeration date
12/02/2005
Last updated
06/06/2024
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