Provider Demographics
NPI:1417099433
Name:KREUTZER, MICHAEL CHRISTOPH (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHRISTOPH
Last Name:KREUTZER
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 1:52 LAIDLEY ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-2733
Mailing Address - Country:US
Mailing Address - Phone:415-333-7500
Mailing Address - Fax:415-431-3195
Practice Address - Street 1:1140 OAK ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2217
Practice Address - Country:US
Practice Address - Phone:415-431-7701
Practice Address - Fax:415-431-3195
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA478452084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A478450Medicaid
CAF26704Medicare ID - Type UnspecifiedSFGH UPIN - MEDICARE