Provider Demographics
NPI:1609850791
Name:KREAGER, MICHAEL C (MD FACC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:KREAGER
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 8TH AVE
Mailing Address - Street 2:SUITE 3060
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5082
Mailing Address - Country:US
Mailing Address - Phone:262-656-8271
Mailing Address - Fax:262-656-8255
Practice Address - Street 1:6308 8TH AVE
Practice Address - Street 2:STE 3060
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5082
Practice Address - Country:US
Practice Address - Phone:262-656-8271
Practice Address - Fax:262-656-8255
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35765207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32014900Medicaid
WI1609850791Medicaid
F42166Medicare UPIN
WI000332085Medicare PIN
WI322500112Medicare PIN