Provider Demographics
NPI:1881186773
Name:KRUSE, TODD A (DO)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:A
Last Name:KRUSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1152
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3415 S SEPULVEDA BLVD STE 1250
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-6292
Practice Address - Country:US
Practice Address - Phone:844-676-1037
Practice Address - Fax:833-664-4548
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.172794207Q00000X
KS05-50903207Q00000X
AZ009149207Q00000X
IN02008364A207Q00000X
UT14215278-1234207Q00000X
WI13089-321207Q00000X
PAOS024759207Q00000X
NC01760207Q00000X
IL336.128366207QA0401X
UT12415278-8904207QA0401X
MS35040207QA0401X
CA20A24263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS200019511Medicaid