Provider Demographics
NPI:1497998678
Name:T KENNETH KRUTKY MD INC
Entity Type:Organization
Organization Name:T KENNETH KRUTKY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:T
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:KRUTKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-929-4221
Mailing Address - Street 1:PO BOX 26125
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-6125
Mailing Address - Country:US
Mailing Address - Phone:330-493-9004
Mailing Address - Fax:330-493-7123
Practice Address - Street 1:802 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1049
Practice Address - Country:US
Practice Address - Phone:330-929-4221
Practice Address - Fax:330-929-7517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0433371Medicare PIN