Provider Demographics
NPI:1952517062
Name:STEPHEN J. KRUSZKA D.O., P.C.
Entity Type:Organization
Organization Name:STEPHEN J. KRUSZKA D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KRUSZKA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:402-391-5022
Mailing Address - Street 1:PO BOX 241963
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-6963
Mailing Address - Country:US
Mailing Address - Phone:402-391-5022
Mailing Address - Fax:402-496-3561
Practice Address - Street 1:7710 MERCY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2346
Practice Address - Country:US
Practice Address - Phone:402-391-5022
Practice Address - Fax:402-496-3561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE36394653201Medicaid
NEDB3753Medicare PIN
099508Medicare ID - Type Unspecified