Provider Demographics
NPI:1902836125
Name:KROH, JAN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN MARIE
Middle Name:
Last Name:KROH
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 1:153 W 151ST ST
Mailing Address - Street 2:STE 100
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5348
Mailing Address - Country:US
Mailing Address - Phone:913-764-1125
Mailing Address - Fax:
Practice Address - Street 1:153 W 151ST ST
Practice Address - Street 2:STE 100
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5348
Practice Address - Country:US
Practice Address - Phone:913-764-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430231207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H89309Medicare UPIN
KSM82C534Medicare PIN