Healthcare Provider Details

I. General information

NPI: 1598799553
Provider Name (Legal Business Name): HARRY SCOTT KRULEWITCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 SW CORONADO ST
PORTLAND OR
97219-7625
US

IV. Provider business mailing address

1101 SW CORONADO ST
PORTLAND OR
97219-7625
US

V. Phone/Fax

Practice location:
  • Phone: 360-260-8225
  • Fax:
Mailing address:
  • Phone: 360-260-8225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD10273
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: