Provider Demographics
NPI:1639188196
Name:KRUCZEK, MICHAEL E (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:KRUCZEK
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 461629
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78246-1629
Mailing Address - Country:US
Mailing Address - Phone:210-615-7480
Mailing Address - Fax:210-614-4972
Practice Address - Street 1:10007 HUEBNER RD STE 203
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1646
Practice Address - Country:US
Practice Address - Phone:210-615-7480
Practice Address - Fax:210-614-4972
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4181174400000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00RD41OtherBLUE CROSS BLUE SHIELD TX
TX130267102Medicaid
TX00RD41OtherBLUE CROSS BLUE SHIELD TX