Individual
TIMOTHY P KRESOWIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
40027
IA
208800000X
Urology Physician
R-7811
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0073643
—
IA
01
—
07364
BLUE CROSS BLUE SHIELD
IA
05
—
0904060
—
IA
01
—
91338
BLUE CROSS BLUE SHIELD
IL
Enumeration date
05/22/2007
Last updated
10/01/2021
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