Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 5883 | SD |
Y | 207X00000X | Orthopaedic Surgeon | 5883 | SD |
NPI | 1508870619 |
---|---|
Provider Name | Chris C Krouse |
First Address | Mitchell, SD 57301-2969 |
Second Address | Mitchell, SD 57301-2969 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 11/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I25487 | (02) | IL |