Provider Demographics
NPI:1497333553
Name:KRUPKA, ANGELA CATHERINE
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:CATHERINE
Last Name:KRUPKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9190 SPRINGFIELD RD APT 16C
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-4115
Mailing Address - Country:US
Mailing Address - Phone:440-862-1071
Mailing Address - Fax:
Practice Address - Street 1:6715 TIPPECANOE RD STE D100
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-7123
Practice Address - Country:US
Practice Address - Phone:330-286-0462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2025-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH36.004182213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program