Provider Demographics
NPI:1700214970
Name:ELIZABETH KRONLAGE DO LLC
Entity Type:Organization
Organization Name:ELIZABETH KRONLAGE DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KRONLAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:520-822-8442
Mailing Address - Street 1:48 N TUCSON BLVD
Mailing Address - Street 2:#100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-4757
Mailing Address - Country:US
Mailing Address - Phone:520-822-8442
Mailing Address - Fax:520-306-4937
Practice Address - Street 1:48 N TUCSON BLVD
Practice Address - Street 2:#100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-4757
Practice Address - Country:US
Practice Address - Phone:520-822-8442
Practice Address - Fax:520-306-4937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5064261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty