Provider Demographics
NPI:1588859300
Name:KENNETH N KRUTSCH MDSC
Entity Type:Organization
Organization Name:KENNETH N KRUTSCH MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-682-3426
Mailing Address - Street 1:2101 BEASER AVE
Mailing Address - Street 2:ANNEX A
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-3638
Mailing Address - Country:US
Mailing Address - Phone:715-682-3426
Mailing Address - Fax:715-682-3442
Practice Address - Street 1:2101 BEASER AVE
Practice Address - Street 2:ANNEX A
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-3638
Practice Address - Country:US
Practice Address - Phone:715-682-3426
Practice Address - Fax:715-682-3442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19044-20174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30233600Medicaid
WIB84993Medicare UPIN