Basic Information
| Provider Information | |||||||||
| NPI: | 1891178042 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRATER | ||||||||
| FirstName: | TIMOTHY | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 355 E ERIE ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606113167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3122381000 | ||||||||
| FaxNumber: | 3122381208 | ||||||||
| Practice Location | |||||||||
| Address1: | 355 E ERIE ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606113167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3122381000 | ||||||||
| FaxNumber: | 3122381208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2015 | ||||||||
| LastUpdateDate: | 08/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 036-157434 | IL | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 5315070000 | MI | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2081P0010X | 125.073529 | IL | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pediatric Rehabilitation Medicine | 2081P0010X | 036-157434 | IL | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pediatric Rehabilitation Medicine |
No ID Information.