Provider Demographics
NPI:1891777850
Name:KRAGT, JOEL L (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:L
Last Name:KRAGT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1661 FEEHANVILLE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-6017
Mailing Address - Country:US
Mailing Address - Phone:708-280-9109
Mailing Address - Fax:847-305-8601
Practice Address - Street 1:1661 FEEHANVILLE DR STE 120
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-6017
Practice Address - Country:US
Practice Address - Phone:847-305-8600
Practice Address - Fax:847-305-8601
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2021-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-085227207Q00000X
IL036085227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF58392Medicare UPIN