DR. KENNETH EDWARD KRUCZEK (NPI# 1306849419) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306849419 |
| Entity Type | Individual |
| Full Name | DR. KENNETH EDWARD KRUCZEK |
| Credential | D.O |
| Practice Address |
3506 21st St Suite 605 Lubbock TX 79410-1212 |
| Mailing Address |
3420 22nd Pl Lubbock TX 79410-1314 |
| Practice Telephone | 8067254130 |
| Practice Fax Number | 8067237137 |
| Mailing Telephone | 8067255844 |
| Mailing Fax Number | 8067236532 |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2011-10-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | E6120 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | 000Q2634 | 05 | |
| TX | 034876502 | 05 | |
| TX | BCBS TX | 8CT089 | 01 |
| Street Address |
3506 21ST ST SUITE 605 |
| City | LUBBOCK |
| State | TX |
| Zip Code | 79410-1212 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134661358 | Fred Gregory Sebastian Iv | Physician Assistant | 3506 21st St, Suite 507, Lubbock, TX 79410-1212 | 2016-11-07 |
| 1295284396 | Caitlin Sarah Blair | Nurse Practitioner | 3506 21st St, Ste 607, Lubbock, TX 79410-1212 | 2016-09-29 |
| 1851744957 | Brandy Gilbrett Trevino | Nurse Practitioner | 3506 21st St, Ste. 507, Lubbock, TX 79410-1212 | 2016-07-13 |
| 1366848541 | Gabriella Trevino Davis | Nurse Practitioner | 3506 21st St, Lubbock, TX 79410-1212 | 2014-11-14 |
| 1760817324 | Monica Caraveo Pilip | Nurse Practitioner | 3506 21st St, Suite 203, Lubbock, TX 79410-1212 | 2013-09-13 |
| 1770829012 | Susan Doctolero | Nurse Practitioner | 3506 21st St, Suite 302, Lubbock, TX 79410-1212 | 2012-12-13 |
| 1164798989 | Amy D'ann Gordon | Nurse Practitioner | 3506 21st St, Suite 607, Lubbock, TX 79410-1212 | 2012-03-27 |
| 1164791257 | Sharronda Richawn Bradford | Nurse Practitioner | 3506 21st St, Suite605, Lubbock, TX 79410-1212 | 2011-12-20 |
| 1477821106 | Theophilus O Olumese | Hospitalist | 3506 21st St, Suite 605, Lubbock, TX 79410-1212 | 2011-12-08 |
| 1831484831 | Katie L. Hendley | Psychiatry & Neurology | 3506 21st St, Suite 400, Lubbock, TX 79410-1212 | 2011-06-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548878267 | Covenant Medical Center | Clinic/Center | 3615 19th, Lifestyle Centre-east Parking Garage, Lubbock, TX 79410 | 2020-07-20 |
| 1669038626 | Hub City Anesthesia | Nurse Anesthetist, Certified Registered | 3416 22nd Street, Lubbock, TX 79410 | 2019-05-15 |
| 1912447418 | Lubbock Surgery Center, LLC | Clinic/Center | 3416 22nd St, Lubbock, TX 79410 | 2017-03-02 |
| 1871032698 | Lezlee Berry | Pharmacist | 3615 19th Street, Lubbock, TX 79410 | 2017-02-13 |
| 1376914101 | Matthew Cotton | Nurse Practitioner | 2424 Quaker Ave, Lubbock, TX 79410 | 2015-10-20 |
| 1841534864 | Frank Nwabugwu | Pharmacist | 4120 34th Street, Lubbock, TX 79410 | 2012-11-15 |
| 1689954794 | Dharmendra Kumar | Pediatrics | Covenant Children's Hospital, 4000 24th Street, Lubbock, TX 79410 | 2011-08-19 |
| 1518277177 | T.r.m. Rao, M.d., P.a. | Colon & Rectal Surgery | 3809 22nd Street, Suite C, Lubbock, TX 79410 | 2010-10-18 |
| 1700196672 | Hanford Consultations P.a. | Family Medicine | 4000 22nd Place Suite 100, Lubbock, TX 79410 | 2010-10-13 |
| 1336452598 | Amanda Collins | Specialist | 4801 34th Street, Lubbock, TX 79410 | 2010-07-16 |
| Find all providers in zip 79410 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790341949 | Michael Mcpherson, M.d. P.a. | Internal Medicine | 5406 Colgate St, Lubbock, TX 79416 | 2019-05-14 |
| 1053974659 | Jeremy David Purser | Internal Medicine | 3601 4th St # Ms 9400, Lubbock, TX 79430-0002 | 2019-04-18 |
| 1295220481 | Men's Health Institute, LLC | Internal Medicine | 6616 Milwaukee Ave Ste 400, Lubbock, TX 79424-0627 | 2018-06-29 |
| 1639526338 | Sofia Kennedy Prieto | Internal Medicine | 3601 4th St # Ms 6211, Lubbock, TX 79430-6211 | 2016-05-23 |
| 1639525314 | Nishi Garg | Internal Medicine | 4 Th St, 3601, Lubbock, TX 79430-0001 | 2016-05-11 |
| 1477908903 | Kenneth Iwuji | Internal Medicine | 3601 4th Street Stop 9410, Lubbock, TX 79430-3419 | 2016-05-03 |
| 1346694254 | Peter Khalil | Internal Medicine | 3601 4th St Rm 4b076, Lubbock, TX 79430-0002 | 2016-04-17 |
| 1922472349 | Salman Ahmad, M.d., P.a. | Internal Medicine | 3620 Interstate 27, Lubbock, TX 79404-2348 | 2015-11-23 |
| 1154741148 | Roshni Narayanan | Internal Medicine | 4004 82nd St Ste G, Lubbock, TX 79423-2065 | 2014-04-17 |
| 1053602300 | Rasikh Ajmal | Internal Medicine | 3601 4th St Ms 9410, Lubbock, TX 79430 | 2011-04-20 |
| Find all providers in LUBBOCK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.