Provider Demographics
NPI:1083028013
Name:KROENKE, JON (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:KROENKE
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:P O BOX 1066
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68602
Mailing Address - Country:US
Mailing Address - Phone:402-564-7200
Mailing Address - Fax:402-564-7210
Practice Address - Street 1:3775 45TH AVENUE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601
Practice Address - Country:US
Practice Address - Phone:402-564-7200
Practice Address - Fax:402-564-7210
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7239208000000X
NE30105208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics