1730271594 NPI number — DR. M. ELAINE KROSSE DPM

Table of content: DR. M. ELAINE KROSSE DPM (NPI 1730271594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730271594 NPI number — DR. M. ELAINE KROSSE DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KROSSE
Provider First Name:
M.
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KROSSE
Provider Other First Name:
MARY
Provider Other Middle Name:
ELAINE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1730271594
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
860 E BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELYRIA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44035-6542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-322-4220
Provider Business Mailing Address Fax Number:
440-322-4713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
860 E BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELYRIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44035-6542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-322-4220
Provider Business Practice Location Address Fax Number:
440-322-4713
Provider Enumeration Date:
09/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  36002297 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 42587891 . This is a "MED. MUT. OF OHIO/SELECT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0644379 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8333415578 . This is a "MED. MUT. OF OHIO/GMCS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000116728 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 480006005 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com