MEDICARE: T KENNETH KRUTKY MD INC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1497998678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T KENNETH KRUTKY MD INC

Provider Business Mailing Address
First Line	:	PO BOX 26125
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44319-6125
Country	:	US
Telephone Number	:	330-493-9004
Fax Number	:	330-493-7123

Provider Business Practice Location Address
First Line	:	802 GRAHAM RD
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-1049
Country	:	US
Telephone Number	:	330-929-4221
Fax Number	:	330-929-7517

Authorized Official
Title or Position	:	OWNER
Name	:	DR. T KENNETH KRUTKY
Credential	:	MD
Telephone Number	:	330-929-4221

Provider Enumeration Date	:	04/17/2009
Last Update Date	:	07/02/2009

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