=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821367699
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATHRYN A. KROEGER, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2011
-----------------------------------------------------
Last Update Date | 02/08/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8330 NAAB RD
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46260-5925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-879-0802
-----------------------------------------------------
Fax | 317-879-0332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8330 NAAB RD
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46260-5925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-879-0802
-----------------------------------------------------
Fax | 317-879-0332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | M.D./OWNER
-----------------------------------------------------
Name | MRS. KATHRYN A KROEGER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 317-879-0802
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 01036171A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------