Provider Demographics
NPI:1043260995
Name:KROLL, CATHERINE A (DO)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:KROLL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 EXPLORER ST
Mailing Address - Street 2:
Mailing Address - City:GWINN
Mailing Address - State:MI
Mailing Address - Zip Code:49841-2813
Mailing Address - Country:US
Mailing Address - Phone:906-346-4924
Mailing Address - Fax:
Practice Address - Street 1:135 E. M-35
Practice Address - Street 2:
Practice Address - City:GWINN
Practice Address - State:MI
Practice Address - Zip Code:49841
Practice Address - Country:US
Practice Address - Phone:906-346-9275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI113395739Medicaid
MI085520052OtherBLUE CROSS BLUE SHIELD MI
MI0P22650002Medicare PIN
MI085520052OtherBLUE CROSS BLUE SHIELD MI
MIE25613Medicare UPIN