Healthcare Provider Details

I. General information

NPI: 1538160627
Provider Name (Legal Business Name): MICHAEL KROLL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 PAA ST
KAHULUI HI
96732-3606
US

IV. Provider business mailing address

23 PAA ST
KAHULUI HI
96732-3606
US

V. Phone/Fax

Practice location:
  • Phone: 808-877-8955
  • Fax: 808-877-8957
Mailing address:
  • Phone: 808-877-8955
  • Fax: 808-877-8957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD5089
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: