MEDICARE: LAUREN MELLOR KROLCZYK 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
1	207V00000X	Obstetrics & Gynecology Physician	5101019937	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1992895221	OTHER	MI	PRACTICE NPI
2	1750415915	OTHER	MI	PRACTICE NPI

General Provider Information

NPI Number	:	1528322070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN MELLOR KROLCZYK D.O

Provider Business Mailing Address
First Line	:	39200 GARFIELD RD STE B
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-4095
Country	:	US
Telephone Number	:	586-286-6060
Fax Number	:	586-286-5055

Provider Business Practice Location Address
First Line	:	39200 GARFIELD RD STE B
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-4095
Country	:	US
Telephone Number	:	586-286-6060
Fax Number	:	586-286-5055

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

Provider Enumeration Date	:	06/29/2012
Last Update Date	:	01/22/2026

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