Provider Demographics
NPI:1538126396
Name:KRUSS, DANIEL M (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
Last Name:KRUSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7398
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-7398
Mailing Address - Country:US
Mailing Address - Phone:847-405-0068
Mailing Address - Fax:847-940-9568
Practice Address - Street 1:520 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1022
Practice Address - Country:US
Practice Address - Phone:847-405-0068
Practice Address - Fax:847-940-9568
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC41970Medicare UPIN
IL476180Medicare ID - Type Unspecified