MEDICARE: MS. KATHLEEN A KROLL

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	174400000X	Specialist	057003028	IL

General Provider Information

NPI Number	:	1639320997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN A KROLL

Provider Business Mailing Address
First Line	:	36180 HEMLOCK ST W
Second Line	:
City	:	UNION CITY
State	:	PA
Zip	:	16438-4306
Country	:	US
Telephone Number	:	814-860-0501
Fax Number	:

Provider Business Practice Location Address
First Line	:	36180 HEMLOCK ST W
Second Line	:
City	:	UNION CITY
State	:	PA
Zip	:	16438-4306
Country	:	US
Telephone Number	:	814-860-0501
Fax Number	:

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

Provider Enumeration Date	:	10/06/2008
Last Update Date	:	10/06/2008

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