Provider Demographics
NPI:1699852780
Name:KROL, BRYAN JEFFREY (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:JEFFREY
Last Name:KROL
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 N GRAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-4107
Mailing Address - Country:US
Mailing Address - Phone:859-781-4900
Mailing Address - Fax:859-572-3044
Practice Address - Street 1:40 N GRAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-4107
Practice Address - Country:US
Practice Address - Phone:859-781-4900
Practice Address - Fax:859-572-3044
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39347207YX0901X
KY36347207Y00000X, 207YP0228X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH701342Medicaid
000000194039OtherANTHEM
10-00769OtherUNITED HEALTHCARE
KY64027923Medicaid
OH35079139OtherOH MEDICAL LICENSE
KY36347OtherKY MEDICAL LICENSE
KY65917965Medicaid
IN100015770Medicaid
IN200323170Medicaid
1187975OtherCHA
2573298OtherAETNA
IN1047169Medicaid
IN172650-HMedicare ID - Type UnspecifiedIN MEDICARE GROUP NUMBER
IN1047169Medicaid
IN100015770Medicaid
H32901Medicare UPIN
KY2168Medicare ID - Type UnspecifiedKY GROUP NUMBER