Provider Demographics
NPI:1861464836
Name:KRULJAC, STEPHEN J (DPM)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:KRULJAC
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:J
Other - Last Name:KRULJAC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM, PC
Mailing Address - Street 1:495 WATERFRONT DR E
Mailing Address - Street 2:SUITE 230
Mailing Address - City:HOMESTEAD
Mailing Address - State:PA
Mailing Address - Zip Code:15120-1140
Mailing Address - Country:US
Mailing Address - Phone:412-461-1108
Mailing Address - Fax:412-461-5490
Practice Address - Street 1:495 WATERFRONT DR E
Practice Address - Street 2:SUITE 230
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-1140
Practice Address - Country:US
Practice Address - Phone:412-461-1108
Practice Address - Fax:412-461-5490
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002458L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000413491OtherAETNA PIN
PA100960OtherHIGHMARK INDIVIDUAL PROV#
PA1205011277OtherDMERC NPI
PA1007366OtherGATEWAY HMO PROV NUMBER
PA1710911912OtherHIGHMARK GROUP NPI
PA1225214968OtherGROUP NPI NUMBER
PA455619OtherHIGHMARK GROUP NUMBER
PA0009128330001Medicaid
PA100960XXTOtherMC GROUP PROVIDER NUMBER
PA1156610001OtherDMERC PROVIDER NUMBER
PA1225214968OtherRR MEDICARE GROUP NPI
PA0009128330001Medicaid
PA0009128330001Medicaid