Basic Information
Provider Information | |||||||||
NPI: | 1861585986 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KRONLAGE | ||||||||
FirstName: | STEVEN | ||||||||
MiddleName: | C | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1040 GULF BREEZE PKWY | ||||||||
Address2: | SUITE 209 | ||||||||
City: | GULF BREEZE | ||||||||
State: | FL | ||||||||
PostalCode: | 325617808 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8509168480 | ||||||||
FaxNumber: | 8509168499 | ||||||||
Practice Location | |||||||||
Address1: | 1040 GULF BREEZE PKWY | ||||||||
Address2: | SUITE 209 | ||||||||
City: | GULF BREEZE | ||||||||
State: | FL | ||||||||
PostalCode: | 325617808 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8509168480 | ||||||||
FaxNumber: | 8509168499 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/02/2006 | ||||||||
LastUpdateDate: | 02/28/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME86563 | FL | N |   | Other Service Providers | Specialist |   | 207X00000X | ME86563 | FL | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 2190109 | 01 | FL | UNITED HEALTHCARE | OTHER | C412 | 01 | FL | HEALTH FIRST | OTHER | 59085285 | 01 | AL | BCBS ALABAMA | OTHER | 274012500 | 05 | FL |   | MEDICAID | 81526 | 01 | FL | BCBS FLORIDA | OTHER | P00213251 | 01 | FL | MEDICARE RAILROAD | OTHER |