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NPI Code Detail

MEDICARE: DR. MARK R KROLL D.O.

MEDICARE: DR. MARK R KROLL D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician30436-21WI
2207P00000XEmergency Medicine Physician30436-21WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124030499
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK R KROLL D.O.
Provider Business Mailing Address
First Line : 2864 SUSSEX RD
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-7475
Country : US
Telephone Number : 920-680-8000
Fax Number :
Provider Business Practice Location Address
First Line : 2253 W MASON ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54303-4706
Country : US
Telephone Number : 920-327-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2006
Last Update Date : 05/19/2026

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Directions to “ DR. MARK R KROLL D.O.” Practice Location

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