Provider Demographics
NPI:1700836129
Name:KRUPNICK, KURT ANDREW (MD)
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:ANDREW
Last Name:KRUPNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3181 CLEARWATER DR STE B
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7196
Mailing Address - Country:US
Mailing Address - Phone:928-227-2796
Mailing Address - Fax:928-515-2455
Practice Address - Street 1:3181 CLEARWATER DR STE B
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7196
Practice Address - Country:US
Practice Address - Phone:928-227-2796
Practice Address - Fax:928-515-2455
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42104207R00000X, 207R00000X
VT0420009722207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT043346203 0078OtherCIGNA
VT317297OtherMVP
VT043346203012OtherTRICARE
VTKRUP11138661OtherBC BS OF VERMONT
VT0VN1768Medicaid
VT0VN1768Medicaid
VTG71177Medicare UPIN
VT317297OtherMVP