Healthcare Provider Details

I. General information

NPI: 1851868673
Provider Name (Legal Business Name): SCOTT MICHAEL KROHN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 12/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 EXCELSIOR BLVD
ST LOUIS PARK MN
55426-4702
US

IV. Provider business mailing address

4953 EMERSON AVE S
MINNEAPOLIS MN
55419-5333
US

V. Phone/Fax

Practice location:
  • Phone: 612-281-8243
  • Fax:
Mailing address:
  • Phone: 612-281-8243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2277
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: