Basic Information
| Provider Information | |||||||||
| NPI: | 1285990481 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KROOK | ||||||||
| FirstName: | KAELYN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5673 PEACHTREE DUNWOODY RD | ||||||||
| Address2: | STE 150 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042971780 | ||||||||
| FaxNumber: | 4042527255 | ||||||||
| Practice Location | |||||||||
| Address1: | 5673 PEACHTREE DUNWOODY RD | ||||||||
| Address2: | STE 150 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042971780 | ||||||||
| FaxNumber: | 4042527255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2012 | ||||||||
| LastUpdateDate: | 04/11/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | GA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Y00000X | 77844 | GA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.