Provider Demographics
NPI:1790960433
Name:KRYGOWSKI, BRUCE R (MD)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:R
Last Name:KRYGOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1840 POST ROAD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54677-2832
Mailing Address - Country:US
Mailing Address - Phone:715-344-1513
Mailing Address - Fax:715-344-2261
Practice Address - Street 1:1840 POST ROAD
Practice Address - Street 2:SUITE 7
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54677-2832
Practice Address - Country:US
Practice Address - Phone:715-344-1513
Practice Address - Fax:715-344-2261
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI213530202082S0099X, 2086S0122X
WI2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
B54354Medicare UPIN