Healthcare Provider Details

I. General information

NPI: 1497685556
Provider Name (Legal Business Name): BRENT MICHAEL KRUPP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3634 72ND PL SE
MERCER ISLAND WA
98040-3353
US

IV. Provider business mailing address

3634 72ND PL SE
MERCER ISLAND WA
98040-3353
US

V. Phone/Fax

Practice location:
  • Phone: 206-947-2429
  • Fax:
Mailing address:
  • Phone: 206-947-2429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: