Individual
KEVIN MATTHEW KRISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
675 N SAINT CLAIR ST STE 21-100, CHICAGO, IL 60611-5970
(312) 695-0990
(312) 695-1106
Mailing address
675 N SAINT CLAIR ST STE 21-100, CHICAGO, IL 60611-5970
(312) 695-0990
(312) 695-1106
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085.006901
IL
363A00000X
Physician Assistant
PA04678
TX
363AM0700X
Medical Physician Assistant
Primary
085006901
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
184834301
—
TX
01
—
8Y0727
BCBS
TX
01
—
P00677105
RR MEDICARE
TX
Enumeration date
10/18/2006
Last updated
08/07/2025
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