1275562696 NPI number — DR. JAMES A KROEZE DO

Table of content: DR. JAMES A KROEZE DO (NPI 1275562696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275562696 NPI number — DR. JAMES A KROEZE DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KROEZE
Provider First Name:
JAMES
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275562696
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9625 RED ARROW HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGMAN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49106-9559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-465-6050
Provider Business Mailing Address Fax Number:
269-465-3134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9625 RED ARROW HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGMAN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49106-9559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-465-6050
Provider Business Practice Location Address Fax Number:
269-465-3134
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  5101012762 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 80176004 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 270381199 . This is a "GROUP TAX ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 01-31294 . This is a "PHP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 085110106 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1538397120 . This is a "GROUP NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4333777 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5460964 . This is a "CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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