Provider Demographics
NPI:1659419794
Name:KROMELIS, FRANK JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:JOHN
Last Name:KROMELIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12201 MERIT DR
Mailing Address - Street 2:SUITE 440
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2213
Mailing Address - Country:US
Mailing Address - Phone:972-490-6556
Mailing Address - Fax:972-490-6189
Practice Address - Street 1:12201 MERIT DR
Practice Address - Street 2:SUITE 440
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2213
Practice Address - Country:US
Practice Address - Phone:972-490-6556
Practice Address - Fax:972-490-6189
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096434802Medicaid
TX0034EDOtherBLUE CROSS/BLUE SHIELD
TX00224LMedicare ID - Type Unspecified
TX096434802Medicaid