Provider Demographics
NPI:1619948023
Name:KROGSTAD, KAREN J (MD)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:J
Last Name:KROGSTAD
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 1:1700 W TOWNLINE ST
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-1054
Mailing Address - Country:US
Mailing Address - Phone:641-782-7091
Mailing Address - Fax:641-782-3830
Practice Address - Street 1:1610 W TOWNLINE ST
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-1066
Practice Address - Country:US
Practice Address - Phone:641-782-2131
Practice Address - Fax:641-782-6425
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32609207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA38043OtherBXBS
IA4154641Medicaid
IA37342OtherBXBS
IA4154641Medicaid
IA37342OtherBXBS