Provider Demographics
NPI:1457930356
Name:KRUEGER, OWEN (MD)
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:
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 1:912 CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5032
Mailing Address - Country:US
Mailing Address - Phone:715-965-6977
Mailing Address - Fax:
Practice Address - Street 1:533 BOLIVAR ST RM 451B
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1349
Practice Address - Country:US
Practice Address - Phone:504-568-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2555774Medicaid