Organization
DOUGLAS A KRUSE MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS A KRUSE MD (OWNER)
(618) 526-2222
Entity
Organization
Contact information
Practice address
9495 HOLY CROSS LN, SUITE 103, BREESE, IL 62230-3510
(618) 526-2222
(618) 526-7680
Mailing address
9495 HOLY CROSS LN, SUITE 103, BREESE, IL 62230-3510
(618) 526-2222
(618) 526-7680
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036098255
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036098255
—
IL
01
—
IL BLUESHIELD
01427671
IL
Enumeration date
10/20/2006
Last updated
06/13/2008
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