Healthcare Provider Details

I. General information

NPI: 1437185600
Provider Name (Legal Business Name): ADAM M. KRUCZAY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 S ALMA SCHOOL RD #119B
MESA AZ
85210-4031
US

IV. Provider business mailing address

2487 S GILBERT RD #106-606
GILBERT AZ
85295-8899
US

V. Phone/Fax

Practice location:
  • Phone: 480-664-7490
  • Fax: 480-664-7512
Mailing address:
  • Phone: 480-664-7490
  • Fax: 480-664-7512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC003387L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0676
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: