Provider Demographics
NPI:1295814366
Name:KROLIK, MARY LYNN FINNELL (MD)
Entity Type:Individual
Prefix:
First Name:MARY LYNN
Middle Name:FINNELL
Last Name:KROLIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 E STATE HIGHWAY 114 FL 1
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-4412
Mailing Address - Country:US
Mailing Address - Phone:623-889-1605
Mailing Address - Fax:
Practice Address - Street 1:431 E STATE HWY, 1 FLOOR
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE
Practice Address - State:TX
Practice Address - Zip Code:76092
Practice Address - Country:US
Practice Address - Phone:602-685-3846
Practice Address - Fax:602-685-3808
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS59582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ768319Medicaid
AZ106097Medicare ID - Type Unspecified
AZ101281Medicare UPIN