Provider Demographics
NPI:1376660175
Name:KRUEGER, THOMAS CARLETON (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:CARLETON
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 WALLACE RD
Mailing Address - Street 2:SUITE C414
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4854
Mailing Address - Country:US
Mailing Address - Phone:615-781-9499
Mailing Address - Fax:615-781-3882
Practice Address - Street 1:397 WALLACE RD
Practice Address - Street 2:SUITE C414
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4854
Practice Address - Country:US
Practice Address - Phone:615-781-9499
Practice Address - Fax:615-781-3882
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2016-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 14230208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN31971501Medicaid
TNB04739Medicare UPIN
TNP00432659Medicare PIN
TN31971501Medicare PIN