Healthcare Provider Details

I. General information

NPI: 1861528812
Provider Name (Legal Business Name): CAROLINA VEIN SPECIALISTS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 NEW GARDEN RD
GREENSBORO NC
27410-3206
US

IV. Provider business mailing address

1130 NEW GARDEN RD
GREENSBORO NC
27410-3206
US

V. Phone/Fax

Practice location:
  • Phone: 336-218-8346
  • Fax: 336-218-0145
Mailing address:
  • Phone: 336-218-8346
  • Fax: 336-218-0145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL P. KRUSCH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 336-218-8346