Provider Demographics
NPI:1275562696
Name:KROEZE, JAMES A (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:KROEZE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9625 RED ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:BRIDGMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49106-9559
Mailing Address - Country:US
Mailing Address - Phone:269-465-6050
Mailing Address - Fax:269-465-3134
Practice Address - Street 1:9625 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:BRIDGMAN
Practice Address - State:MI
Practice Address - Zip Code:49106-9559
Practice Address - Country:US
Practice Address - Phone:269-465-6050
Practice Address - Fax:269-465-3134
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012762207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI80176004OtherRAILROAD MEDICARE
MI270381199OtherGROUP TAX ID
MI01-31294OtherPHP
MI085110106OtherBLUE CROSS
MI1538397120OtherGROUP NPI
MI4333777Medicaid
MI5460964OtherCIGNA
MI5460964OtherCIGNA
MI01-31294OtherPHP
MIMI2051049Medicare PIN