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General NPI Number Information
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NPI Number | 1700054590
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Entity Type | Individual
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Provider Name | ELIZABETH KROCHAK M.D.,P.A.
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Gender | Female
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Dates
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Enumeration Date | 02/14/2008
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Last Update Date | 08/24/2010
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Provider Practice Location Address
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Address Line | 106 N OLD KINGS RD SUITE B
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City | ORMOND BEACH
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State | FL
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Zip | 32174
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Country | US
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Telephone | 386-673-5561
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Fax | 386-672-3192
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Provider Business Mailing Address
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Address Line | 106 N OLD KINGS RD SUITE B
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City | ORMOND BEACH
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State | FL
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Zip | 32174
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Country | US
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Telephone | 386-673-5561
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Fax | 386-672-3192
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME46477
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License Number State | FL
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