Provider Demographics
NPI:1568457273
Name:KRUECK, KATHERINE JANE (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JANE
Last Name:KRUECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1021 COUNTRY CLUB RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2484
Mailing Address - Country:US
Mailing Address - Phone:641-501-7337
Mailing Address - Fax:614-434-2701
Practice Address - Street 1:7420 GOODING BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-7086
Practice Address - Country:US
Practice Address - Phone:740-657-8000
Practice Address - Fax:740-657-8100
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078939K208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2426128Medicaid