Provider Demographics
NPI:1730196304
Name:KROGSTAD, JUDI A (MD)
Entity type:Individual
Prefix:DR
First Name:JUDI
Middle Name:A
Last Name:KROGSTAD
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 28949
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-8949
Mailing Address - Country:US
Mailing Address - Phone:559-228-5400
Mailing Address - Fax:559-228-4412
Practice Address - Street 1:7085 N WHITNEY AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8029
Practice Address - Country:US
Practice Address - Phone:559-437-7338
Practice Address - Fax:559-437-7153
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG072335171100000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G723350OtherSTATE ID