Provider Demographics
NPI:1235166984
Name:KRASINSKI, EDMUND JR (DO)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:
Last Name:KRASINSKI
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36234
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-6234
Mailing Address - Country:US
Mailing Address - Phone:520-531-0600
Mailing Address - Fax:520-531-1190
Practice Address - Street 1:6879 N ORACLE RD
Practice Address - Street 2:SUITE 133
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4284
Practice Address - Country:US
Practice Address - Phone:520-531-0600
Practice Address - Fax:520-531-1190
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2544207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ184177Medicaid
AZZ106783Medicare ID - Type Unspecified
AZF79372Medicare UPIN