Healthcare Provider Details

I. General information

NPI: 1952524266
Provider Name (Legal Business Name): BENITA KRUZEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 PAINTED HILLS DR
IVINS UT
84738-6082
US

IV. Provider business mailing address

313 PAINTED HILLS DR
IVINS UT
84738-6082
US

V. Phone/Fax

Practice location:
  • Phone: 435-656-3313
  • Fax:
Mailing address:
  • Phone: 435-656-3313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036-085303
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier036-085303
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerILLINOIS STATE LICENSE
# 2
Identifier5132066-1205
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerUTAH STATE LICENSE
# 3
IdentifierK5135
Identifier TypeOTHER
Identifier StateTX
Identifier IssuerTEXAS STATE LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: