Provider Demographics
NPI:1669568531
Name:KROEKER, ELIZABETH JEANNE (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JEANNE
Last Name:KROEKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2600 N WOODLAWN BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-2729
Mailing Address - Country:US
Mailing Address - Phone:316-260-1690
Mailing Address - Fax:316-260-1691
Practice Address - Street 1:2600 N WOODLAWN BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-2729
Practice Address - Country:US
Practice Address - Phone:316-260-1690
Practice Address - Fax:316-260-1691
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2020-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS04-29454207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSH59207Medicare UPIN