Healthcare Provider Details

I. General information

NPI: 1326122789
Provider Name (Legal Business Name): CURTIS J KROH PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 KUNDERT ST
TURTLE LAKE ND
58575-4205
US

IV. Provider business mailing address

PO BOX 535
TURTLE LAKE ND
58575
US

V. Phone/Fax

Practice location:
  • Phone: 701-448-9225
  • Fax:
Mailing address:
  • Phone: 701-448-9225
  • Fax: 701-448-9224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAC0266
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: