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Individual

TIMOTHY STEPHEN KRUSE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DPM

Contact information

Practice address
750 N FRANKLIN ST, STE 102, CHICAGO, IL 60654-6263
(312) 280-7886
(312) 280-9547
Mailing address
750 N FRANKLIN ST, STE 102, CHICAGO, IL 60654-6263
(312) 280-7886
(312) 280-9547

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
016005211
IL
213EP0504X
Public Medicine Podiatrist
016005211
IL
213EP1101X
Primary Podiatric Medicine Podiatrist
016-005211
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016005211
IL
213ES0131X
Foot Surgery Podiatrist
016-005211
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00002465026 05
UNITED HEALTHCARE
IL
01
316-002321
CSR
IL
01
7032671
AETNA
IL
01
7072691
CIGNA
IL
Enumeration date
06/23/2005
Last updated
06/23/2021
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