Provider Demographics
NPI:1942425517
Name:PROGRESSIVE FAMILY HEALTH
Entity Type:Organization
Organization Name:PROGRESSIVE FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KROL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-875-9995
Mailing Address - Street 1:1110 ARBOR DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-9285
Mailing Address - Country:US
Mailing Address - Phone:217-875-9995
Mailing Address - Fax:
Practice Address - Street 1:1110 ARBOR DR
Practice Address - Street 2:SUITE D
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-9285
Practice Address - Country:US
Practice Address - Phone:217-875-9995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2007-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05822882OtherBLUE CROSS
IL05822882OtherBLUE CROSS