Healthcare Provider Details

I. General information

NPI: 1538321757
Provider Name (Legal Business Name): JON KRONBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2008
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CENTER DR
SPRINGFIELD OH
45504-2687
US

IV. Provider business mailing address

100 MEDICAL CENTER DR
SPRINGFIELD OH
45504-2687
US

V. Phone/Fax

Practice location:
  • Phone: 937-523-1000
  • Fax:
Mailing address:
  • Phone: 937-523-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35.099882
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number200801782
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: