Provider Demographics
NPI:1326089558
Name:KRUGER, CALVIN L II (PA)
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:L
Last Name:KRUGER
Suffix:II
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-3125
Mailing Address - Country:US
Mailing Address - Phone:620-672-7415
Mailing Address - Fax:620-672-7414
Practice Address - Street 1:420 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-3125
Practice Address - Country:US
Practice Address - Phone:620-672-7415
Practice Address - Fax:620-672-7414
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00632363AM0700X
KS1500632363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100088840BMedicaid
KS2050536901Medicaid
KS173877Medicare ID - Type UnspecifiedRURAL HEALTH MEDICARE
KS2050536901Medicaid