Provider Demographics
NPI:1437185600
Name:KRUCZAY, ADAM M (DPM)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:M
Last Name:KRUCZAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2487 S GILBERT RD #106-606
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-8899
Mailing Address - Country:US
Mailing Address - Phone:480-664-7490
Mailing Address - Fax:480-664-7512
Practice Address - Street 1:2815 S ALMA SCHOOL RD
Practice Address - Street 2:#119B
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-4031
Practice Address - Country:US
Practice Address - Phone:480-664-7490
Practice Address - Fax:480-664-7512
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003387L213ES0103X
AZ0676213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ394459Medicaid
AZDP9577OtherMEDICARE RR
AZZ133406Medicare PIN
AZDP9577OtherMEDICARE RR