=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326578287
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL G. KRYNSKI DPM PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2017
-----------------------------------------------------
Last Update Date | 05/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 BONAVENTURE WAY STE 133
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77479-8006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-205-3681
-----------------------------------------------------
Fax | 832-915-2360
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 BONAVENTURE WAY STE 133
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77479-8006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-205-3681
-----------------------------------------------------
Fax | 832-915-2360
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE COORDINATOR
-----------------------------------------------------
Name | SANDRA RIOS-BOND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-755-4637
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP1100X
-----------------------------------------------------
Taxonomy Name | Podiatric Clinic/Center
-----------------------------------------------------
License Number | 1863
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------