Basic Information
| Provider Information | |||||||||
| NPI: | 1699874776 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KROLL | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | DORIAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 502 ROCK CREEK DR | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481041864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346620409 | ||||||||
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| Practice Location | |||||||||
| Address1: | 555 TOWNER ST | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481985752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345446716 | ||||||||
| FaxNumber: | 7345446732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 02/04/2014 | ||||||||
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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 | 2084P0802X | 4301028333 | MI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry |
No ID Information.