Individual
JERRY E KRUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
612 N 11TH ST, QUINCY, IL 62301-2662
(217) 224-9484
(217) 224-7950
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-7578
(217) 545-1884
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-068809
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036068809
—
IL
Enumeration date
12/23/2005
Last updated
05/19/2016
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