Provider Demographics
NPI:1851367767
Name:KREUSSER, KATHERINE L (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:L
Last Name:KREUSSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8888 LADUE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2056
Mailing Address - Country:US
Mailing Address - Phone:314-862-4050
Mailing Address - Fax:314-862-1141
Practice Address - Street 1:8888 LADUE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2056
Practice Address - Country:US
Practice Address - Phone:314-862-4050
Practice Address - Fax:314-862-1141
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR4B88208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE10401Medicare UPIN