MEDICARE: JULIE S CRONK 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	207N00000X	Dermatology Physician	42849	MN
2	207ND0101X	MOHS-Micrographic Surgery Physician	42849	MN

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	:	1467406843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE S CRONK M.D.

Provider Business Mailing Address
First Line	:	60 PLATO BLVD E
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55107-1827
Country	:	US
Telephone Number	:	651-209-1600
Fax Number	:	651-291-9169

Provider Business Practice Location Address
First Line	:	3555 WILLOW LAKE BLVD
Second Line	:	SUITE 240
City	:	SAINT PAUL
State	:	MN
Zip	:	55110-5131
Country	:	US
Telephone Number	:	651-770-0110
Fax Number	:	651-770-0134

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	09/28/2020

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