MEDICARE: ERNEST KRUG

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	2080P0006X	Developmental - Behavioral Pediatrics Physician	4301060939	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3506314650	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1366402075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNEST KRUG

Provider Business Mailing Address
First Line	:	3601 W 13 MILE RD
Second Line	:	400-FSC/PCS
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-6712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1695 W 12 MILE RD
Second Line	:	STE. 120
City	:	BERKLEY
State	:	MI
Zip	:	48072-2182
Country	:	US
Telephone Number	:	248-691-4744
Fax Number	:

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

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	07/08/2007

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Directions to “ ERNEST KRUG ” Practice Location

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