MEDICARE: MICHAEL N KRUTZIK MD A MEDICAL CORPORATION

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	207RP1001X	Pulmonary Disease Physician	A66632	CA

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	1447290168	OTHER	CA	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1528253572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL N KRUTZIK MD A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	528 G ST
Second Line	:
City	:	BRAWLEY
State	:	CA
Zip	:	92227-2411
Country	:	US
Telephone Number	:	760-344-6355
Fax Number	:

Provider Business Practice Location Address
First Line	:	790 W ORANGE AVE STE C
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-3274
Country	:	US
Telephone Number	:	760-352-6766
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL N KRUTZIK
Credential	:	MD
Telephone Number	:	760-352-6766

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	02/05/2008

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