MEDICARE: MR. MICHAEL STEPHEN KRUG PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP129767	TX

General Provider Information

NPI Number	:	1336502558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL STEPHEN KRUG PMHNP

Provider Business Mailing Address
First Line	:	10107 IRON OAK LN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1927
Country	:	US
Telephone Number	:	210-854-5549
Fax Number	:

Provider Business Practice Location Address
First Line	:	10107 IRON OAK LN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1927
Country	:	US
Telephone Number	:	210-854-5549
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2016
Last Update Date	:	04/04/2016

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