Provider Demographics
NPI:1841684669
Name:KREUTZBERG, JEFFREY (DPM)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:KREUTZBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43440-2034
Mailing Address - Country:US
Mailing Address - Phone:419-341-9208
Mailing Address - Fax:
Practice Address - Street 1:1114 LAKE ST
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:OH
Practice Address - Zip Code:43440-2034
Practice Address - Country:US
Practice Address - Phone:419-341-9208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.001863213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0OtherNONE