Basic Information
| Provider Information | |||||||||
| NPI: | 1083028013 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KROENKE | ||||||||
| FirstName: | JON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P O BOX 1066 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025647200 | ||||||||
| FaxNumber: | 4025647210 | ||||||||
| Practice Location | |||||||||
| Address1: | 3775 45TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025647200 | ||||||||
| FaxNumber: | 4025647210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2014 | ||||||||
| LastUpdateDate: | 01/29/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 7239 | NE | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 30105 | NE | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.