Kroetsch, Corey John

Kroetsch, Corey John is an individual health care provider with primary practice located at 801 Broadway N , Fargo ND 58102-3641. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Kroetsch, Corey John can be contacted via phone (701) 234-5884.

Contact Information

Primary practice address
801 Broadway N Fargo ND 58102-3641
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X RL10258 North Dakota
Allopathic & Osteopathic Physicians / Surgery 208600000X 12072 North Dakota

Profile Details

NPI number 1194987669
LBN Legal business name Kroetsch, Corey John
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 26th, 2008
Last updated Jan 17th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194987669 NPPES
North Dakota MEDICAID 16491

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