Provider Demographics
NPI:1457301319
Name:CATHERINE A KROLL, DO,PC
Entity Type:Organization
Organization Name:CATHERINE A KROLL, DO,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-346-9275
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:GWINN
Mailing Address - State:MI
Mailing Address - Zip Code:49841-1330
Mailing Address - Country:US
Mailing Address - Phone:906-346-9275
Mailing Address - Fax:906-346-5161
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0805210582OtherBLUE CROSS BLUE SHIELD MI
MI104839571Medicaid
MI085520052OtherBLUE CROSS BLUE SHIELD MI
MI113395739Medicaid
080116795Medicare PIN
MI104839571Medicaid
MIE25613Medicare UPIN
MII42178Medicare UPIN
DA0164Medicare PIN