MEDICARE: KATHIE LEE CRONIN M.D.

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
1	207Q00000X	Family Medicine Physician	G33249	CA

General Provider Information

NPI Number	:	1205836160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHIE LEE CRONIN M.D.

Provider Business Mailing Address
First Line	:	600 COFFEE RD
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95355-4201
Country	:	US
Telephone Number	:	209-521-6097
Fax Number	:

Provider Business Practice Location Address
First Line	:	3612 DALE RD
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95356-0500
Country	:	US
Telephone Number	:	209-522-0146
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	02/28/2013

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