Provider Demographics
NPI:1497755375
Name:KRENGEL, SAMUEL S (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:S
Last Name:KRENGEL
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 1:950 N YORK RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2950
Mailing Address - Country:US
Mailing Address - Phone:630-887-0580
Mailing Address - Fax:630-887-0618
Practice Address - Street 1:950 N YORK RD
Practice Address - Street 2:SUITE 208
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2950
Practice Address - Country:US
Practice Address - Phone:630-887-0580
Practice Address - Fax:630-887-0618
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088985174400000X
IL036-088985208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00268552OtherRAILROAD MEDICARE
IL036088985Medicaid
ILK20472Medicare ID - Type Unspecified
ILP00268552OtherRAILROAD MEDICARE
IL036088985Medicaid