Provider Demographics
NPI:1134187446
Name:KRUMPOS, GERALD L (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:L
Last Name:KRUMPOS
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 1:2825 HUNTERS TRL
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-3429
Mailing Address - Country:US
Mailing Address - Phone:608-742-7161
Mailing Address - Fax:608-745-3060
Practice Address - Street 1:2825 HUNTERS TRL
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-3429
Practice Address - Country:US
Practice Address - Phone:608-742-7161
Practice Address - Fax:608-745-3060
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35494-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1134187446Medicaid
WIK400176651Medicare PIN
WI080108630Medicare PIN
E89510Medicare UPIN
WI4347OtherDEAN HEALTH INSURANCE
WI32055300Medicaid
WI000413215Medicare PIN