MEDICARE: DR. BRENT MICHAEL KRUPP MD

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1497685556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENT MICHAEL KRUPP MD

Provider Business Mailing Address
First Line	:	3634 72ND PL SE
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-3353
Country	:	US
Telephone Number	:	206-947-2429
Fax Number	:

Provider Business Practice Location Address
First Line	:	3634 72ND PL SE
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-3353
Country	:	US
Telephone Number	:	206-947-2429
Fax Number	:

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

Provider Enumeration Date	:	05/21/2026
Last Update Date	:	05/21/2026

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