Provider Demographics
NPI:1831144963
Name:KRUG, MARSHALL R (BA, LMT, NCTMB)
Entity type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:R
Last Name:KRUG
Suffix:
Gender:M
Credentials:BA, LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3042 N FEDERAL HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1400
Mailing Address - Country:US
Mailing Address - Phone:954-232-0147
Mailing Address - Fax:954-563-1079
Practice Address - Street 1:3042 N FEDERAL HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1400
Practice Address - Country:US
Practice Address - Phone:954-232-0147
Practice Address - Fax:954-563-1079
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 39823174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688384200Medicaid