Provider Demographics
NPI:1538192398
Name:KROL, KORNELIA (MD)
Entity type:Individual
Prefix:DR
First Name:KORNELIA
Middle Name:
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 1:6438 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-2935
Mailing Address - Country:US
Mailing Address - Phone:773-775-7883
Mailing Address - Fax:773-775-7885
Practice Address - Street 1:6438 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-2935
Practice Address - Country:US
Practice Address - Phone:773-775-7883
Practice Address - Fax:773-775-7885
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089290207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001632465OtherBLUE CROSS/BLUE SHIELD
IL036089290Medicaid
IL0001632465OtherBLUE CROSS/BLUE SHIELD
IL214511Medicare ID - Type UnspecifiedGROUP NUMBER