MEDICARE: DR. JOHN JOSEPH KRUTSICK II DO

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	207Q00000X	Family Medicine Physician	OS17419	FL
2	208M00000X	Hospitalist Physician	OS17419	FL

General Provider Information

NPI Number	:	1871052704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN JOSEPH KRUTSICK II DO

Provider Business Mailing Address
First Line	:	21298 OLEAN BLVD
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6765
Country	:	US
Telephone Number	:	941-629-1181
Fax Number	:

Provider Business Practice Location Address
First Line	:	21298 OLEAN BLVD
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6765
Country	:	US
Telephone Number	:	941-629-1181
Fax Number	:

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

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	06/03/2024

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