Organization
CENTRAL ILLINOIS DERMATOLOGY, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER T KROODSMA M.D. (PRESIDENT)
(309) 691-2903
Entity
Organization
Contact information
Practice address
5401 N KNOXVILLE AVE, SUITE 115, PEORIA, IL 61614-5095
(309) 691-2903
(309) 691-2909
Mailing address
5401 N KNOXVILLE AVE, SUITE 115, PEORIA, IL 61614-5095
(309) 691-2903
(309) 691-2909
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
042004157
IL
Other
Enumeration date
10/10/2006
Last updated
07/13/2010
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