Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | IL | |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 2825020 | WI |
NPI | 1255519310 |
---|---|
Provider Name | Carol Krohm |
First Address | Harvard, IL 60033-0430 |
Second Address | Chicago, IL 60622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2008 |
Last Update Date | 31/01/2008 |