Provider Demographics
NPI:1659473247
Name:CRONIN, KEVIN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:CRONIN
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 1:170 NORTH LAKEWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-5945
Mailing Address - Country:US
Mailing Address - Phone:224-569-4000
Mailing Address - Fax:224-569-4001
Practice Address - Street 1:170 NORTH LAKEWOOD ROAD
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-5945
Practice Address - Country:US
Practice Address - Phone:224-569-4000
Practice Address - Fax:224-569-4001
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-105826208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-105826Medicaid
IL203637Medicare ID - Type Unspecified
IL036-105826Medicaid