Provider Demographics
NPI:1558311175
Name:KREIS, SAMUEL DUANE (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:DUANE
Last Name:KREIS
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 1:272 LONDON MOUNTAIN VIEW DR # NA
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-6601
Mailing Address - Country:US
Mailing Address - Phone:606-877-2850
Mailing Address - Fax:606-877-2857
Practice Address - Street 1:272 LONDON MOUNTAIN VIEW DR STE 3
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-6601
Practice Address - Country:US
Practice Address - Phone:606-877-2850
Practice Address - Fax:606-877-2857
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37696207Q00000X
TNMD0000037275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64067051Medicaid
C92392OtherCHI PROVIDER NUMBER
KY9927OtherMEDICARE GROUP NUMBER
KY65944589Medicaid
KYDE2149OtherRAILROAD MEDICARE NUMBER
H86731Medicare UPIN
KY64067051Medicaid