Healthcare Provider Details

I. General information

NPI: 1558424812
Provider Name (Legal Business Name): TRACY LYNN KRUZICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 ERDMAN WAY STE 315
LEOMINSTER MA
01453-1840
US

IV. Provider business mailing address

PO BOX 1000 DEPT 453
MEMPHIS TN
38148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 978-537-4805
  • Fax:
Mailing address:
  • Phone: 828-575-2625
  • Fax: 828-350-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number238418
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberDR.0046645
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: