Provider Demographics
NPI:1952492779
Name:KROEGER, KATHRYN ANN (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:KROEGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8330 NAAB RD
Mailing Address - Street 2:214
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5925
Mailing Address - Country:US
Mailing Address - Phone:317-879-0802
Mailing Address - Fax:317-879-0332
Practice Address - Street 1:8330 NAAB RD
Practice Address - Street 2:214
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5925
Practice Address - Country:US
Practice Address - Phone:317-879-0802
Practice Address - Fax:317-879-0332
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036171174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IND95648Medicare UPIN
IN678410Medicare ID - Type UnspecifiedPROVIDER NUMBER