Provider Demographics
NPI:1235176116
Name:PAIGE KREEGEL MD PA
Entity Type:Organization
Organization Name:PAIGE KREEGEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:VANIER
Authorized Official - Last Name:KREEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-629-4888
Mailing Address - Street 1:3420 TAMIAMI TRL
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8127
Mailing Address - Country:US
Mailing Address - Phone:941-629-4888
Mailing Address - Fax:941-629-5935
Practice Address - Street 1:3420 TAMIAMI TRL
Practice Address - Street 2:SUITE 2
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8127
Practice Address - Country:US
Practice Address - Phone:941-629-4888
Practice Address - Fax:941-629-5935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42565208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty