Healthcare Provider Details

I. General information

NPI: 1730567090
Provider Name (Legal Business Name): KONRAD ALEKSANDER KROSS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KONRAD A KRACH DO

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLEASANT VALLEY RD STE 405
OWENSBORO KY
42303-9774
US

IV. Provider business mailing address

PO BOX 23229
OWENSBORO KY
42304-3229
US

V. Phone/Fax

Practice location:
  • Phone: 270-417-7850
  • Fax: 270-417-7859
Mailing address:
  • Phone: 270-688-1330
  • Fax: 270-688-1338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberTP708
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number04902
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: