Provider Demographics
NPI:1730271594
Name:KROSSE, M. ELAINE (DPM)
Entity type:Individual
Prefix:DR
First Name:M.
Middle Name:ELAINE
Last Name:KROSSE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:ELAINE
Other - Last Name:KROSSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:860 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6542
Mailing Address - Country:US
Mailing Address - Phone:440-322-4220
Mailing Address - Fax:440-322-4713
Practice Address - Street 1:860 E BROAD ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6542
Practice Address - Country:US
Practice Address - Phone:440-322-4220
Practice Address - Fax:440-322-4713
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002297213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH42587891OtherMED. MUT. OF OHIO/SELECT
OH0644379Medicaid
OH8333415578OtherMED. MUT. OF OHIO/GMCS
OH000000116728OtherANTHEM BC/BS
OH480006005OtherRAILROAD MEDICARE
OHBE0586391Medicare PIN
OH000000116728OtherANTHEM BC/BS
OH480006005OtherRAILROAD MEDICARE