Provider Demographics
NPI:1184892820
Name:MYRON I. KRUPP, D.P.M., INC.
Entity type:Organization
Organization Name:MYRON I. KRUPP, D.P.M., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:I
Authorized Official - Last Name:KRUPP
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:817-284-8271
Mailing Address - Street 1:7208 GLENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8693
Mailing Address - Country:US
Mailing Address - Phone:817-284-8271
Mailing Address - Fax:817-284-2940
Practice Address - Street 1:7208 GLENVIEW DR
Practice Address - Street 2:
Practice Address - City:RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8693
Practice Address - Country:US
Practice Address - Phone:817-284-8271
Practice Address - Fax:817-284-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0332261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF160OtherBLUE CROSS
TXF160OtherBLUE CROSS
TXT14279Medicare UPIN