Provider Demographics
NPI:1134158553
Name:KRUEGER, JOSEPH S (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:S
Last Name:KRUEGER
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 1:3355 GLENDALE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-599-1224
Mailing Address - Fax:419-599-1524
Practice Address - Street 1:1600 E RIVERVIEW AVE STE 103
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-9806
Practice Address - Country:US
Practice Address - Phone:419-599-1224
Practice Address - Fax:419-599-1524
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-056423207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0707999Medicaid
OHP00215686OtherRAILROAD
OH0707999Medicaid