Provider Demographics
NPI:1417083478
Name:KRUSCH, MICHAEL P (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:KRUSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1130 NEW GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-3206
Mailing Address - Country:US
Mailing Address - Phone:336-218-8346
Mailing Address - Fax:336-218-0145
Practice Address - Street 1:1130 NEW GARDEN RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-3206
Practice Address - Country:US
Practice Address - Phone:336-218-8346
Practice Address - Fax:336-218-0145
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95-01304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2611222OtherCIGNA
NC1757988OtherUNITED HEALTH CARE
NC190715OtherMEDCOST
NC130W9OtherBCBS NORTH CAROLINA
NC190715OtherMEDCOST
NC2611222OtherCIGNA