Basic Information
| Provider Information | |||||||||
| NPI: | 1477082436 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KREI | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3900 28TH AVENUE DR. | ||||||||
| Address2: | |||||||||
| City: | MOLINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3092816000 | ||||||||
| FaxNumber: | 3092816009 | ||||||||
| Practice Location | |||||||||
| Address1: | 3900 28TH AVENUE DR. | ||||||||
| Address2: | |||||||||
| City: | MOLINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3092816000 | ||||||||
| FaxNumber: | 3092816009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2017 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R-10941 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 036.157609 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.