Provider Demographics
NPI:1548293251
Name:KROUSGRILL, LOIS ANN (MD)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:ANN
Last Name:KROUSGRILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 N COUNTY ROAD 25A STE 112
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1337
Mailing Address - Country:US
Mailing Address - Phone:937-339-8513
Mailing Address - Fax:937-339-8603
Practice Address - Street 1:3130 N COUNTY ROAD 25A STE 112
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1337
Practice Address - Country:US
Practice Address - Phone:937-339-8513
Practice Address - Fax:937-339-8603
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0746832084N0402X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2276942Medicaid
OHKR4230641Medicare PIN
OH2276942Medicaid