Provider Demographics
NPI:1487042057
Name:KRIESBERG, KEITH (PA-C)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:KRIESBERG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2650 WARRENVILLE RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1748
Mailing Address - Country:US
Mailing Address - Phone:630-324-7900
Mailing Address - Fax:630-271-1813
Practice Address - Street 1:133 E BRUSH HILL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5659
Practice Address - Country:US
Practice Address - Phone:630-782-1500
Practice Address - Fax:630-501-0446
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085005853363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical