Provider Demographics
NPI:1376512228
Name:KRUGLIK, GERALD DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:DAVID
Last Name:KRUGLIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GERALD
Other - Middle Name:D
Other - Last Name:KRUGLIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 19378
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-0378
Mailing Address - Country:US
Mailing Address - Phone:323-737-6240
Mailing Address - Fax:323-737-7804
Practice Address - Street 1:2297 W 21ST ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1327
Practice Address - Country:US
Practice Address - Phone:323-737-6240
Practice Address - Fax:323-731-4150
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0340852085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A45778Medicare UPIN