Provider Demographics
NPI:1669546768
Name:KRANZ, VICTORIA (MD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:KRANZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 N WAUKEGAN RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1664
Mailing Address - Country:US
Mailing Address - Phone:847-615-9978
Mailing Address - Fax:
Practice Address - Street 1:33 N WAUKEGAN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1664
Practice Address - Country:US
Practice Address - Phone:847-615-9978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL049-00128OtherBLUE CROSS BLUE SHIELD
IL933140Medicare ID - Type Unspecified