Provider Demographics
NPI:1720015217
Name:KRUG, STEWART (MD)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:
Last Name:KRUG
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 1:1945 CEI DRIVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3311
Mailing Address - Country:US
Mailing Address - Phone:513-984-5133
Mailing Address - Fax:513-569-3941
Practice Address - Street 1:3219 CLIFTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-3027
Practice Address - Country:US
Practice Address - Phone:513-984-5133
Practice Address - Fax:513-281-2313
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-8207207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000020961OtherBCBS
KY64761406Medicaid
IN1002470AMedicaid
KY180032457OtherRAILROAD MEDICARE
OH180032283OtherRAILROAD MEDICARE
OH337880Medicaid
KY180032457OtherRAILROAD MEDICARE
KY64761406Medicaid