Provider Demographics
NPI:1427087063
Name:KROGER, ELLIOTT (MD)
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:
Last Name:KROGER
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:PO BOX 746721
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6721
Mailing Address - Country:US
Mailing Address - Phone:313-733-9730
Mailing Address - Fax:
Practice Address - Street 1:3210 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2204
Practice Address - Country:US
Practice Address - Phone:847-220-4103
Practice Address - Fax:847-693-7029
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-059136207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1982624763OtherBCBS OF IL
04-29526OtherEVERCARE
4932996OtherBCBS OF IL
K24995Medicare PIN
04-29526OtherEVERCARE
4932996OtherBCBS OF IL