Provider Demographics
NPI:1326078858
Name:KRUGER, WILLEM J (DO)
Entity Type:Individual
Prefix:
First Name:WILLEM
Middle Name:J
Last Name:KRUGER
Suffix:
Gender:M
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 189
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-0189
Mailing Address - Country:US
Mailing Address - Phone:812-801-0156
Mailing Address - Fax:812-801-0276
Practice Address - Street 1:1373 E STATE ROAD 62
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-7328
Practice Address - Country:US
Practice Address - Phone:812-801-0156
Practice Address - Fax:812-801-0276
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002076207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100320110AMedicaid
IN419199POtherSIHO
IN000000108109OtherANTHEM BCBS
KY1097668OtherPASSPORT KY MEDICAID
050071818OtherMEDICARE RAILROAD
4123371OtherAETNA
KY64022478Medicaid
KY2436181000OtherPASSPORT ADVANTAGE
IN050071818Medicare PIN
KY2436181000OtherPASSPORT ADVANTAGE
IN412920CMedicare ID - Type Unspecified
IN412920CMedicare PIN