Leo Paul Krusack, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19A-14094 Issued in IL

Practice address

444 N Main St
Glen Ellyn, IL 60137

Phone

(630) 858-1120

Fax

(630) 858-7632

NPI assigned

Nov 27, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689740334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 N MAIN ST",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "60137",
            "telephone_number": "630-858-1120",
            "fax_number": "630-858-7632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 N MAIN ST",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "60137",
            "telephone_number": "630-858-1120",
            "fax_number": "630-858-7632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUSACK",
        "first_name": "LEO",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "19A-14094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara Kosirog
• Cynthia Koskiewicz, LCPC
• Laura Koziej, MA, LPC
• Kristen Powell Therapy and Consulting, LLC
• Whitney Lynn Krug, L.C.P.C.
• Jihad Kudsi, MD
• Karol Kuehn, PTA
• Debbie Kuhn
• Mary Eileen Kungl, M.D.
• Julie P Kupisch, PT

• General Practice Dentistry in Glen Ellyn, IL
• Providers in Glen Ellyn, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.