Provider Demographics
NPI:1609548635
Name:TOLLKUCI, KRIS
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:TOLLKUCI
Suffix:
Gender:M
Credentials:
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 4832
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4832
Mailing Address - Country:US
Mailing Address - Phone:847-722-3559
Mailing Address - Fax:
Practice Address - Street 1:756 N WILLOW RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-1733
Practice Address - Country:US
Practice Address - Phone:847-722-3559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT422-5005-5184OtherINSURANCE