Individual
MATTHEW EVAN KROSIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
550 UNIVERSITY BLVD, INDIANAPOLIS, IN 46202-5149
(317) 944-4600
(317) 948-7055
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01083268A
IN
2085R0204X
Vascular & Interventional Radiology Physician
01083268A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300025200
—
IN
01
—
959090106
MEDICARE PTAN
IN
01
—
Q00114643
RAILROAD PTAN
IN
Enumeration date
04/06/2014
Last updated
12/28/2023
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