Provider Demographics
NPI:1598799553
Name:KRULEWITCH, HARRY SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:SCOTT
Last Name:KRULEWITCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 SW CORONADO ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-7625
Mailing Address - Country:US
Mailing Address - Phone:360-260-8225
Mailing Address - Fax:
Practice Address - Street 1:1101 SW CORONADO ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-7625
Practice Address - Country:US
Practice Address - Phone:360-260-8225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10273207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287059Medicaid
OR287059Medicaid
OR115198Medicare ID - Type UnspecifiedMEDICARE PROVIDER #