Provider Demographics
NPI:1083952220
Name:RONALD A KRUEGER MD INC PS
Entity Type:Organization
Organization Name:RONALD A KRUEGER MD INC PS
Other - Org Name:NORTHWEST SLEEP AND SINUS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-341-4305
Mailing Address - Street 1:828 2ND ST STE C
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-1601
Mailing Address - Country:US
Mailing Address - Phone:425-341-4305
Mailing Address - Fax:
Practice Address - Street 1:828 2ND ST STE C
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-1601
Practice Address - Country:US
Practice Address - Phone:425-341-4305
Practice Address - Fax:888-349-7131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA32364174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG115000456Medicare PIN