Provider Demographics
NPI:1780698159
Name:KRUG, ALVIN K (MD)
Entity type:Individual
Prefix:
First Name:ALVIN
Middle Name:K
Last Name:KRUG
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 1:3003 W GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2042
Mailing Address - Country:US
Mailing Address - Phone:414-352-3100
Mailing Address - Fax:
Practice Address - Street 1:9400 W LINCOLN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2306
Practice Address - Country:US
Practice Address - Phone:414-321-2255
Practice Address - Fax:414-321-2091
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21278174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00705308OtherRR MEDICARE
WI30298100Medicaid
WIP00705308OtherRR MEDICARE
WI01994-0393Medicare PIN
WI46236-0398Medicare PIN