Provider Demographics
NPI:1538477542
Name:CRONIN MEDICAL GROUP, LTD.
Entity Type:Organization
Organization Name:CRONIN MEDICAL GROUP, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CRONIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1815-477-4600
Mailing Address - Street 1:390 E CONGRESS PKWY
Mailing Address - Street 2:SUITE H
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6202
Mailing Address - Country:US
Mailing Address - Phone:815-477-4600
Mailing Address - Fax:815-477-4605
Practice Address - Street 1:390 E CONGRESS PKWY
Practice Address - Street 2:SUITE H
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6202
Practice Address - Country:US
Practice Address - Phone:815-477-4600
Practice Address - Fax:815-477-4605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105826261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105826Medicaid
H75285Medicare UPIN