Provider Demographics
NPI:1609868280
Name:KRUEGER, HEATHER R (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:952-428-0200
Mailing Address - Fax:952-428-0399
Practice Address - Street 1:17599 KENWOOD TRL
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-8330
Practice Address - Country:US
Practice Address - Phone:952-428-0200
Practice Address - Fax:952-428-0399
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN42675207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN390443100Medicaid
MN390443100Medicaid
080010433Medicare ID - Type Unspecified