Provider Demographics
NPI:1043229941
Name:KRUKAS, ANATOLE (MD)
Entity Type:Individual
Prefix:
First Name:ANATOLE
Middle Name:
Last Name:KRUKAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CENTRAL FLORIDA SUBSTANCE ABUSE TREATMENT CENTER
Mailing Address - Street 2:3155 LAKE WORTH RD
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461
Mailing Address - Country:US
Mailing Address - Phone:561-439-8440
Mailing Address - Fax:
Practice Address - Street 1:CENTRAL FLORIDA SUBSTANCE ABUSE TREATMENT CENTER
Practice Address - Street 2:3155 LAKE WORTH RD
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461
Practice Address - Country:US
Practice Address - Phone:561-439-8440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114799207RA0401X
LAAKMD2887208M00000X
NY11421-0000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009917500Medicaid
AR16140001Medicaid
LA2112139Medicaid
ARP00390873OtherRAIL ROAD MEDICARE
AR5N706OtherBCBS
LA2112139Medicaid
LA4M965DJ97Medicare PIN