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

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