Provider Demographics
NPI:1922298439
Name:KREG THERAPEUTICS INC.
Entity Type:Organization
Organization Name:KREG THERAPEUTICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHELLHAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-829-8904
Mailing Address - Street 1:2240 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-2218
Mailing Address - Country:US
Mailing Address - Phone:312-829-8904
Mailing Address - Fax:312-829-8909
Practice Address - Street 1:907 N BLUFF RD
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-5816
Practice Address - Country:US
Practice Address - Phone:314-740-9694
Practice Address - Fax:312-829-8909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID