Kroodsma, Christopher T

Kroodsma, Christopher T is an individual health care provider with primary practice located at 5401 N Knoxville Ave Suite 115, Peoria IL 61614-5098. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Kroodsma, Christopher T can be contacted via phone (309) 691-2903.

Contact Information

Primary practice address
5401 N Knoxville Ave Suite 115 Peoria IL 61614-5098
Phone: (309) 691-2903
Fax: (309) 691-2909
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 03110443 Illinois

Profile Details

NPI number 1336230051
LBN Legal business name Kroodsma, Christopher T
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 27th, 2006
Last updated Apr 22nd, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336230051 NPPES
Illinois MEDICAID 036110443

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