Active NPI
Michael Kruk, MSW
- Clinical Social Worker
- Paw Paw, MI
National Provider Identifier
1881706273
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6801067648
- Practice address
- 404 Hazen St
Suite L3
Paw Paw, MI 49079-1040 - Phone
- (269) 657-1595
- Fax
- (269) 657-1534
- NPI assigned
- Aug 31, 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6801067648 | MI | Primary |
Addresses
Primary practice location
404 Hazen St
Suite L3
Paw Paw, MI 49079-1040
Mailing address
404 Hazen St
Suite L3
Paw Paw, MI 49079-1040
Phone (269) 657-1595
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 700H060020 | Other | MI | BCBSM |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801067648 | MI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413417600000",
"number": "1881706273",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "404 HAZEN ST",
"address_2": "SUITE L3",
"city": "PAW PAW",
"state": "MI",
"postal_code": "490791040",
"telephone_number": "269-657-1595",
"fax_number": "269-657-1534"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 HAZEN ST",
"address_2": "SUITE L3",
"city": "PAW PAW",
"state": "MI",
"postal_code": "490791040",
"telephone_number": "269-657-1595",
"fax_number": "269-657-1534"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUK",
"first_name": "MICHAEL",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2014-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801067648",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM",
"identifier": "700H060020",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Paw Paw, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 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.