Provider Demographics
NPI:1730567090
Name:KROSS, KONRAD ALEKSANDER (DO)
Entity type:Individual
Prefix:
First Name:KONRAD
Middle Name:ALEKSANDER
Last Name:KROSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:KONRAD
Other - Middle Name:A
Other - Last Name:KRACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-1330
Mailing Address - Fax:270-688-1338
Practice Address - Street 1:1301 PLEASANT VALLEY RD STE 405
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-9774
Practice Address - Country:US
Practice Address - Phone:270-417-7850
Practice Address - Fax:270-417-7859
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP708207RI0200X
390200000X
KY04902207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program