Basic Information
Provider Information
NPI: 1457301319
EntityType: 2
ReplacementNPI:  
OrganizationName: CATHERINE A KROLL, DO,PC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1330
Address2:  
City: GWINN
State: MI
PostalCode: 498411330
CountryCode: US
TelephoneNumber: 9063469275
FaxNumber: 9063465161
Practice Location
Address1: 135 E. M-35
Address2:  
City: GWINN
State: MI
PostalCode: 49841
CountryCode: US
TelephoneNumber: 9063469275
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/11/2006
LastUpdateDate: 05/19/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: KROLL
AuthorizedOfficialFirstName: CATHERINE
AuthorizedOfficialMiddleName: A
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 9063469275
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X5101008621MIY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
080521058201MIBLUE CROSS BLUE SHIELD MIOTHER
10483957105MI MEDICAID
08552005201MIBLUE CROSS BLUE SHIELD MIOTHER
11339573905MI MEDICAID


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