Healthcare Provider Details

I. General information

NPI: 1770534513
Provider Name (Legal Business Name): HENDRIKUS G KROUWER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 N LAKE DR. STE G01 CSM CANCER CENTER-MILWAUKEE
MILWAUKEE WI
53211-4528
US

IV. Provider business mailing address

2350 N LAKE DR. STE G01 CSM CANCER CENTER-MILWAUKEE
MILWAUKEE WI
53211-4528
US

V. Phone/Fax

Practice location:
  • Phone: 414-298-7250
  • Fax:
Mailing address:
  • Phone: 414-298-7250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number36347
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: