Provider Demographics
NPI:1467590190
Name:KRUPP, RYAN JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JEFFREY
Last Name:KRUPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:9880 ANGIES WAY STE 250
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2865
Practice Address - Country:US
Practice Address - Phone:502-394-6341
Practice Address - Fax:502-394-6340
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41945207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000023033POtherHUMANA- NORTON ORTHO TRAUMA CARE
KY200910490OtherMD WISE- NORTON ORTHO TRAUMA CARE
KY5220599OtherCIGNA- NORTON ORTHO TRAUMA CARE
KY00533045OtherMEDICARE- NORTON ORTHO TRAUMA CARE
KY200910490OtherHEALTHY INDIANA PLAN- NORTON ORTHO TRAUMA CARE
IN200910490OtherMEDICAID INDIANA- NORTON ORTHO TRAUMA CARE
KY3545574000OtherPASSPORT ADVANTAGE- NORTON ORTHO TRAUMA CARE
KY50020863OtherPASSPORT- NORTON ORTHO TRAUMA CARE
KY000000575433OtherANTHEM- NORTON ORTHO TRAUMA CARE
KY7100061920OtherMEDICAID KY- NORTON ORTHO TRAUMA CARE
KYP00694596OtherRAILROAD MEDICARE- NORTON ORTHO TRAUMA CARE