Provider Demographics
NPI:1891735742
Name:KREEGEL, PAIGE VANIER (MD)
Entity Type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:VANIER
Last Name:KREEGEL
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 1:4369 TAMIAMI TRAIL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:33980-2118
Mailing Address - Country:US
Mailing Address - Phone:941-629-4888
Mailing Address - Fax:
Practice Address - Street 1:4369 TAMIAMI TRAIL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE HARBOR
Practice Address - State:FL
Practice Address - Zip Code:33980-2118
Practice Address - Country:US
Practice Address - Phone:941-629-4888
Practice Address - Fax:941-629-5935
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42565208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96292OtherBLUE CROSS BLUE SHIELD FL
FL010065128OtherRAILROAD MEDICARE
FL651117653OtherTAX IDENTIFICATION NUMBER
FL96292XMedicare PIN
FL96292OtherBLUE CROSS BLUE SHIELD FL
FL96292AMedicare PIN