Provider Demographics
NPI:1609515725
Name:KRUEGER, REINHOLD HERBERT
Entity Type:Individual
Prefix:
First Name:REINHOLD
Middle Name:HERBERT
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:REINHOLD
Other - Middle Name:
Other - Last Name:KRUEGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 HAZEL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-2822
Mailing Address - Country:US
Mailing Address - Phone:330-808-0608
Mailing Address - Fax:234-808-4001
Practice Address - Street 1:100 HAZEL DR STE 1
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44067-2822
Practice Address - Country:US
Practice Address - Phone:330-808-0608
Practice Address - Fax:234-808-4001
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health