J Michael Krisko, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Practice address

401 N Wall St
Ste 206
Kankakee, IL 60901-2934

Phone

(815) 939-2012

Fax

(815) 939-0920

NPI assigned

Jan 4, 2007

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

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710034574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 N WALL ST",
            "address_2": "STE 206",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012934",
            "telephone_number": "815-939-2012",
            "fax_number": "815-939-0920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N WALL ST",
            "address_2": "STE 206",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012934",
            "telephone_number": "815-939-2012",
            "fax_number": "815-939-0920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRISKO",
        "first_name": "J",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine R Koebel, ATC
• Jessica Rae Kollmann, MS, RD, LDN
• Eleanor Kotov, M.D.
• Robert Koziol, DO
• Jennifer Jean Kravat, M.S. CCC/SLP-L
• Emily Krzystyniak
• KTK Amazing Grace Home Health Care LTD
• Katherine Kuang
• Ronald Kurzejka, M.D.
• John Lacheta, DO

• General Practice Dentistry in Kankakee, IL
• Providers in Kankakee, 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.