Provider Demographics
NPI:1114929098
Name:KRIEGEL, JEFFREY I (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:I
Last Name:KRIEGEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 SOUTHERN PARKWAY
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-0000
Mailing Address - Country:US
Mailing Address - Phone:502-366-1479
Mailing Address - Fax:502-366-6718
Practice Address - Street 1:4602 SOUTHERN PARKWAY
Practice Address - Street 2:SUITE 1B
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-0000
Practice Address - Country:US
Practice Address - Phone:502-366-1479
Practice Address - Fax:502-366-6718
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00355213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP400028204Medicare PIN