MEDICARE: SCARLETT MARION KROENCKE DPM

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	213E00000X	Podiatrist	E3832	CA
2	213ES0103X	Foot & Ankle Surgery Podiatrist	E3832	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00119813	OTHER	CA	RAIL ROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1750331666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCARLETT MARION KROENCKE DPM

Provider Business Mailing Address
First Line	:	1712 PICASSO AVE
Second Line	:	SUITE C
City	:	DAVIS
State	:	CA
Zip	:	95618-0546
Country	:	US
Telephone Number	:	530-753-6280
Fax Number	:	530-753-6281

Provider Business Practice Location Address
First Line	:	1712 PICASSO AVE
Second Line	:	SUITE C
City	:	DAVIS
State	:	CA
Zip	:	95618-0546
Country	:	US
Telephone Number	:	530-753-6280
Fax Number	:	530-753-6281

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/15/2009

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Directions to “ SCARLETT MARION KROENCKE DPM” Practice Location

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