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General NPI Number Information
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NPI Number | 1558424812
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Entity Type | Individual
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Provider Name | TRACY LYNN KRUZICK MD
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Gender | Female
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 80 ERDMAN WAY STE 315
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City | LEOMINSTER
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State | MA
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Zip | 01453-1840
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Country | US
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Telephone | 978-537-4805
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1000 DEPT 453
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City | MEMPHIS
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State | TN
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Zip | 38148-0001
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Country | US
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Telephone | 828-575-2625
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Fax | 828-350-2174
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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 | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 238418
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | DR.0046645
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License Number State | CO
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