Provider Demographics
NPI:1528059185
Name:KROSKA, DAVID A (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:KROSKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-654-3630
Mailing Address - Fax:320-654-3657
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3630
Practice Address - Fax:320-654-3657
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26065207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1123626OtherFIRST HEALTH PLAN
763006OtherARAZ GROUP AMERICAS PPO
HP25467OtherHEALTH PARTNERS
110423OtherUCARE
254005OtherPREFERRED ONE
380303100OtherMEDICAL ASSISTANCE
0702776OtherMEDICA HEALTH PLANS
50A47KROtherBLUE CROSS BLUE SHIELD
CN3904Medicare ID - Type UnspecifiedRR MEDICARE
1123626OtherFIRST HEALTH PLAN
160027912Medicare ID - Type UnspecifiedRR MEDICARE
D75697Medicare UPIN