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General NPI Number Information
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NPI Number | 1366703563
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Entity Type | Individual
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Provider Name | KAMIL KRUKOWSKI DO
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Gender | Male
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 252 MCHENRY ST
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City | BURLINGTON
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State | WI
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Zip | 53105-1828
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Country | US
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Telephone | 262-767-6484
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 735044
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City | CHICAGO
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State | IL
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Zip | 60673-5044
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 63604-21
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101019677
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number | 63604
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License Number State | WI
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