Individual
DANIEL J KRUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2900 FOXFIELD RD, SUITE 200, ST CHARLES, IL 60174-5799
(630) 377-7900
(630) 377-8007
Mailing address
2900 FOXFIELD RD, SUITE 200, ST CHARLES, IL 60174-5799
(630) 377-7900
(630) 377-8007
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036098663
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0222075
BLUE CRSS GROUP NUMBER
IL
05
—
036098663
—
IL
01
—
363149833
TAX IDENTIFICATION NUMBER
IL
01
—
3631498336019001
CDPG HFS PAYEE ID
IL
Enumeration date
07/05/2006
Last updated
04/10/2013
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