Provider Demographics
NPI:1023053683
Name:MRUK, JOZEF S (MD)
Entity type:Individual
Prefix:
First Name:JOZEF
Middle Name:S
Last Name:MRUK
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:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0035
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:316-689-9102
Practice Address - Street 1:3311 E MURDOCK ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3054
Practice Address - Country:US
Practice Address - Phone:316-689-9370
Practice Address - Fax:316-689-9363
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS26205207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS202931OtherHPK
KS12149464OtherMULTIPLAN
KS17015OtherCOVENTRY
KS058674OtherBCBS
KS100185550CMedicaid
KS12961OtherPHS
KS100185550CMedicaid
E63791Medicare UPIN