Healthcare Provider Details

I. General information

NPI: 1053553768
Provider Name (Legal Business Name): MARY CHRISTA KRUPSKI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 07/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE # MLC7015
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE. MLC 7015
CINCINNATI OH
45229-3126
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4266
  • Fax: 513-636-3549
Mailing address:
  • Phone: 513-636-4266
  • Fax: 513-636-3549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number34012313
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: