Healthcare Provider Details

I. General information

NPI: 1689936775
Provider Name (Legal Business Name): KEVIN PHILLIP KRUL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 PARK CLUB LN STE 100
WILLIAMSVILLE NY
14221-5270
US

IV. Provider business mailing address

192 PARK CLUB LN STE 120
WILLIAMSVILLE NY
14221-5270
US

V. Phone/Fax

Practice location:
  • Phone: 716-204-1101
  • Fax: 716-204-0914
Mailing address:
  • Phone: 716-559-3803
  • Fax: 716-961-4198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number333606-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD17249
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number333606-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: