Provider Demographics
NPI:1033142724
Name:KRONFOL, NOUHAD O (MD)
Entity Type:Individual
Prefix:
First Name:NOUHAD
Middle Name:O
Last Name:KRONFOL
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 1:1997 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-7268
Mailing Address - Country:US
Mailing Address - Phone:662-335-2810
Mailing Address - Fax:
Practice Address - Street 1:1997 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-7268
Practice Address - Country:US
Practice Address - Phone:662-335-4105
Practice Address - Fax:662-378-2879
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11536207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0016033Medicaid
MS390000044OtherMEDICARE
MS390000044OtherMEDICARE