Individual
CANDISE D KROUTIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1001 E PRIMROSE ST, SPRINGFIELD, MO 65807-5155
(417) 875-3000
(417) 875-3383
Mailing address
PO BOX 9007, SPRINGFIELD, MO 65808-9007
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
105768
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107910
BLUE CROSS/BLUE SHIELD
—
05
—
208688317
—
MO
05
—
208688325
—
MO
Enumeration date
06/14/2006
Last updated
12/27/2018
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