Provider Demographics
NPI:1295768257
Name:KROUSKOP, NORMAN W JR (MD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:W
Last Name:KROUSKOP
Suffix:JR
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 1:4710 STATE HIGHWAY 11 W
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75686-8042
Mailing Address - Country:US
Mailing Address - Phone:214-912-6050
Mailing Address - Fax:
Practice Address - Street 1:4710 STATE HIGHWAY 11 W
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:TX
Practice Address - Zip Code:75686-8042
Practice Address - Country:US
Practice Address - Phone:214-912-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1003207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102056202Medicaid
TXC18058Medicare UPIN
TX84M362Medicare ID - Type Unspecified