MEDICARE: KEVIN MICHAEL KRONNER MD

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	208800000X	Urology Physician	4301073699	MI
2	208800000X	Urology Physician	11268	MT

Other Identifiers

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

General Provider Information

NPI Number	:	1215932926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN MICHAEL KRONNER MD

Provider Business Mailing Address
First Line	:	2875 TINA AVENUE, SUITE 101
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808
Country	:	US
Telephone Number	:	406-728-3366
Fax Number	:	406-728-0651

Provider Business Practice Location Address
First Line	:	2875 TINA AVENUE, SUITE 101
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808
Country	:	US
Telephone Number	:	406-728-3366
Fax Number	:	406-728-0651

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	08/23/2024

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