Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 4301078694 | MI |
NPI | 1003843046 |
---|---|
Provider Name | Jonathan Arie Kroll |
First Address | Jackson, MI 49201-2218 |
Second Address | Southfield, MI 48075-4818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 08/07/2007 |