Provider Demographics
NPI:1689936775
Name:KRUL, KEVIN PHILLIP (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PHILLIP
Last Name:KRUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:192 PARK CLUB LN STE 120
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5270
Mailing Address - Country:US
Mailing Address - Phone:716-559-3803
Mailing Address - Fax:716-961-4198
Practice Address - Street 1:192 PARK CLUB LN STE 100
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5270
Practice Address - Country:US
Practice Address - Phone:716-204-1101
Practice Address - Fax:716-204-0914
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333606-01207X00000X, 207XS0106X
HIMD17249207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMD-17249OtherMD