Provider Demographics
NPI:1821181009
Name:KRUSZKA, PAUL S (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:KRUSZKA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13701 FM 624 MEDICAL SQUARE
Mailing Address - Street 2:D-4
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410
Mailing Address - Country:US
Mailing Address - Phone:361-387-5597
Mailing Address - Fax:361-767-2324
Practice Address - Street 1:13701 FM 624 MEDICAL SQUARE
Practice Address - Street 2:D-4
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410
Practice Address - Country:US
Practice Address - Phone:361-387-5597
Practice Address - Fax:361-767-2324
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDP0335213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT14280Medicare UPIN
TX00A18LMedicare ID - Type Unspecified