Provider Demographics
NPI:1376856500
Name:KRUEGER, NILOO SHANYA (MD)
Entity type:Individual
Prefix:MRS
First Name:NILOO
Middle Name:SHANYA
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NILOO
Other - Middle Name:
Other - Last Name:RATNAYAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14256 RIVER HILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:MN
Mailing Address - Zip Code:55327-6100
Mailing Address - Country:US
Mailing Address - Phone:612-618-7983
Mailing Address - Fax:
Practice Address - Street 1:14256 RIVER HILLS PKWY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:MN
Practice Address - Zip Code:55327-6100
Practice Address - Country:US
Practice Address - Phone:612-618-7983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301097157208600000X
IN01091080A2086S0127X
MN59465208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315046687OtherSTATE OF MICHIGAN - DEPARTMENT OF COMMUNITY HEALTH: BOARD OF PHARMACY
MI4301097157OtherSTATE OF MICHIGAN - DEPARTMENT OF COMMUNITY HEALTH: BOARD OF MEDICINE