MEDICARE: THEODORE K KRUTKY 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	207R00000X	Internal Medicine Physician	35039773	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	791111263	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	729848	OTHER	OH	BUCKEYE COMMUNITY HEALTH
2	Q013420	OTHER	OH	HOMETOWN HEALTH PLAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000129127	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1609841964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE K KRUTKY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 26125
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44319-6125
Country	:	US
Telephone Number	:	888-719-9020
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	:	330-929-7513

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/09/2009

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Directions to “ THEODORE K KRUTKY M.D.” Practice Location

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