Active NPI
Michael L Kruk, MD
- Family Medicine Physician
- Fort Atkinson, WI
National Provider Identifier
1679524623
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 31765-020
- Practice address
- 740 Reena Ave
Fort Atkinson, WI 53538-3145 - Phone
- (920) 563-0888
- Fax
- (920) 568-3516
- NPI assigned
- May 15, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 31765-020 | WI | Primary |
Addresses
Primary practice location
740 Reena Ave
Fort Atkinson, WI 53538-3145
Mailing address
740 Reena Ave
Fort Atkinson, WI 53538-3145
Phone (920) 563-0888
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31765 | Other | WI | UNITED HEALTHCARE |
| 1000337 | Other | WI | PHYSICIANS PLUS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31765-020 | WI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398816000000",
"number": "1679524623",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "740 REENA AVE",
"city": "FORT ATKINSON",
"state": "WI",
"postal_code": "535383145",
"telephone_number": "920-563-0888",
"fax_number": "920-568-3516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "740 REENA AVE",
"city": "FORT ATKINSON",
"state": "WI",
"postal_code": "535383145",
"telephone_number": "920-563-0888",
"fax_number": "920-568-3516"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUK",
"first_name": "MICHAEL",
"middle_name": "L",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-15",
"last_updated": "2014-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "31765-020",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "31765",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICIANS PLUS",
"identifier": "1000337",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Atkinson, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.