Healthcare Provider Details

I. General information

NPI: 1528331667
Provider Name (Legal Business Name): KROL FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 E ROBBINS STREET
WHEATFIELD IN
46392-6006
US

IV. Provider business mailing address

165 E ROBBINS ST
WHEATFIELD IN
46392-6006
US

V. Phone/Fax

Practice location:
  • Phone: 219-956-3004
  • Fax: 219-956-3006
Mailing address:
  • Phone: 219-956-3004
  • Fax: 219-956-3006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LORI S KROL
Title or Position: OWNER
Credential: RN,MSN,FNP,BC
Phone: 219-956-3004