Provider Demographics
NPI:1023181161
Name:KRONENBERG, JOEL IVAN (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:IVAN
Last Name:KRONENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 ESTATE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0601
Mailing Address - Country:US
Mailing Address - Phone:901-767-3620
Mailing Address - Fax:901-683-0285
Practice Address - Street 1:920 ESTATE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0601
Practice Address - Country:US
Practice Address - Phone:901-767-3620
Practice Address - Fax:901-683-0285
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD09579208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ005882Medicaid
MS00012781Medicaid
TN6013650OtherBCBS
TNQ005882Medicaid