Provider Demographics
NPI:1003929217
Name:KRIEGLER, SAMUEL B (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:B
Last Name:KRIEGLER
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 1:420 LORETTO RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-1628
Mailing Address - Country:US
Mailing Address - Phone:270-692-5139
Mailing Address - Fax:270-699-4628
Practice Address - Street 1:420 LORETTO RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1628
Practice Address - Country:US
Practice Address - Phone:270-692-5139
Practice Address - Fax:270-699-4628
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46375208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN163D2KROtherBCBS
MN324504700Medicaid
MN340019914Medicare PIN
MN340000710Medicare PIN