Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | ME107046 | FL |
NPI | 1124229091 |
---|---|
Provider Name | Mrs. Olga Kromo |
First Address | South Miami, FL 33143-4870 |
Second Address | South Miami, FL 33143-4870 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 25/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D1279Z | (02) | FL |