Provider Demographics
NPI:1659126845
Name:KRUGLOV, OLEG (MD)
Entity type:Individual
Prefix:
First Name:OLEG
Middle Name:
Last Name:KRUGLOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12631 E 17TH AVE # MSC302
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2527
Mailing Address - Country:US
Mailing Address - Phone:775-299-2111
Mailing Address - Fax:
Practice Address - Street 1:12631 E 17TH AVE # MSC302
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2527
Practice Address - Country:US
Practice Address - Phone:775-299-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL.0010444390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program