Provider Demographics
NPI:1467406843
Name:CRONK, JULIE S (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:S
Last Name:CRONK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:60 PLATO BLVD E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-1827
Mailing Address - Country:US
Mailing Address - Phone:651-209-1600
Mailing Address - Fax:651-291-9169
Practice Address - Street 1:3555 WILLOW LAKE BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55110-5131
Practice Address - Country:US
Practice Address - Phone:651-770-0110
Practice Address - Fax:651-770-0134
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2020-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN42849207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN077077900Medicaid
MN077077900Medicaid