Provider Demographics
NPI:1356167845
Name:KRUEGER, CHASE
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 GREEN MEADOW DR APT 5
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-9578
Mailing Address - Country:US
Mailing Address - Phone:616-920-4650
Mailing Address - Fax:
Practice Address - Street 1:261 N MAIN
Practice Address - Street 2:
Practice Address - City:CEDAR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49319-8041
Practice Address - Country:US
Practice Address - Phone:616-920-4650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical