Provider Demographics
NPI:1235119595
Name:KRUEGER, SARA E (DO)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-0460
Mailing Address - Country:US
Mailing Address - Phone:785-229-3367
Mailing Address - Fax:785-229-8461
Practice Address - Street 1:1301 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3537
Practice Address - Country:US
Practice Address - Phone:785-242-9889
Practice Address - Fax:785-229-8447
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0532524207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS106528OtherBLUE CROSS BLUE SHIELD
KS200429600AMedicaid
KS106528Medicare PIN
KS200429600AMedicaid