MEDICARE: DR. JARRETT D KRUSKA M.D

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	208800000X	Urology Physician	21983	OK

General Provider Information

NPI Number	:	1497750533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JARRETT D KRUSKA M.D

Provider Business Mailing Address
First Line	:	615 E OKLAHOMA AVE
Second Line	:	STE 202
City	:	ENID
State	:	OK
Zip	:	73701-5952
Country	:	US
Telephone Number	:	580-233-3230
Fax Number	:	580-233-0698

Provider Business Practice Location Address
First Line	:	615 E OKLAHOMA AVE
Second Line	:	STE 202
City	:	ENID
State	:	OK
Zip	:	73701-5952
Country	:	US
Telephone Number	:	580-233-3230
Fax Number	:	580-233-0698

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/26/2014

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