MEDICARE: KEVIN WILLIAM CROPSEY

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1982193124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN WILLIAM CROPSEY

Provider Business Mailing Address
First Line	:	3132 W OTTERTAIL CT
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-7608
Country	:	US
Telephone Number	:	920-360-7038
Fax Number	:	920-360-7038

Provider Business Practice Location Address
First Line	:	3132 W OTTERTAIL CT
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-7608
Country	:	US
Telephone Number	:	920-360-7038
Fax Number	:

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

Provider Enumeration Date	:	05/03/2018
Last Update Date	:	05/03/2018

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