Provider Demographics
NPI:1053330464
Name:KROL, KATHARINE L (MD)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:L
Last Name:KROL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5545
Mailing Address - Country:US
Mailing Address - Phone:765-448-8000
Mailing Address - Fax:
Practice Address - Street 1:2403 LOY DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-2701
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-446-4351
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028631A2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100362900Medicaid
000000083148OtherBCBS PIN
300075935OtherRAILROAD MEDICARE PIN
INP00744326Medicare PIN
D95596Medicare UPIN
IN100362900Medicaid