Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Philip Krukow

Individual provider Physician Assistant · NPI 1962175109

Philip Krukow is a Physician Assistant in Tooele, Utah. Qualified in 2021, 5 years ago. Practices with Patrick Green MD PLLC, an 8-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Utah.

Years since qualifying
5
Licensed in
UT
In the registry since
2021
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Practice location Address checks out

30 S Tooele Blvd
Tooele, UT 84074-2093
Phone: (435) 248-0333
Fax: (435) 248-0334
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 12591198-1206 (UT)

Record details

NPI number1962175109
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJuly 25, 2021
Last updated in NPPESJanuary 29, 2026
Certification dateJanuary 29, 2026
Mailing address2462 N 720 W, Clinton, UT 84015-9712

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Patrick Green Md Pllc — 8 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

Other providers in Tooele