Provider Demographics
NPI:1376640367
Name:KRUEGER, BARBARA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:LYNN
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 W 95TH ST
Mailing Address - Street 2:STE 413
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:708-346-4055
Mailing Address - Fax:708-499-0948
Practice Address - Street 1:4400 W 95TH ST
Practice Address - Street 2:STE 413
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453
Practice Address - Country:US
Practice Address - Phone:708-346-4055
Practice Address - Fax:708-499-0948
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36086214208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086214Medicaid
IL205171Medicare ID - Type Unspecified
IL036086214Medicaid