Healthcare Provider Details

I. General information

NPI: 1811516032
Provider Name (Legal Business Name): AMANDA KRENITSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 WATERTOWN PLANK RD
MILWAUKEE WI
53226-3548
US

IV. Provider business mailing address

3323 W SWANN AVE
TAMPA FL
33609-4643
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-3106
  • Fax:
Mailing address:
  • Phone: 570-878-8810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number87717-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: