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NPI Code Detail

MEDICARE: GARY J KRUPP PHD

MEDICARE: GARY J KRUPP PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103G00000XClinical NeuropsychologistLP0167MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386648327
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY J KRUPP PHD
Provider Business Mailing Address
First Line : 2828 CHICAGO AVE SOUTH
Second Line : SUITE 200
City : MINNEAPOLIS
State : MN
Zip : 55407-1320
Country : US
Telephone Number : 612-879-1000
Fax Number : 612-879-9116
Provider Business Practice Location Address
First Line : 2828 CHICAGO AVE SOUTH
Second Line : SUITE 200
City : MINNEAPOLIS
State : MN
Zip : 55407-1320
Country : US
Telephone Number : 612-879-1000
Fax Number : 612-879-9116
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2005
Last Update Date : 08/11/2014

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