Individual
KENNETH R. KROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
180 S MAIN ST, CANTON, IL 61520-2608
(309) 647-0201
(309) 649-6880
Mailing address
180 S MAIN ST, CANTON, IL 61520-2608
(309) 647-0201
(309) 649-5101
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036079829
IL
208000000X
Pediatrics Physician
036079829
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0062839
UMWA
IL
01
—
013495
HEALTH ALLIANCE
IL
01
—
02922981
BCBS
IL
05
—
036079829
—
IL
01
—
079829
OSF HEALTHPLANS
IL
01
—
110200867
RR MEDICARE PIN
IL
01
—
180741
HEALTH LINK
IL
01
—
194215197
NPI CLINIC NUMBER
IL
01
—
200397
BLACK LUNG
IL
01
—
CG5172
RR MEDICARE GROUP#
IL
01
—
IL0104
JOHN DEERE
IL
Enumeration date
08/28/2006
Last updated
04/07/2021
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