Provider Demographics
NPI:1669738670
Name:KRIEG, TODD
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:KRIEG
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 1:62 DIETRICH LN
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-3367
Mailing Address - Country:US
Mailing Address - Phone:314-605-9948
Mailing Address - Fax:
Practice Address - Street 1:62 DIETRICH LN
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-3367
Practice Address - Country:US
Practice Address - Phone:314-605-9948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications