Provider Demographics
NPI:1881684918
Name:KRUGER, DAVID MICAH (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICAH
Last Name:KRUGER
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 1:224 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4763
Mailing Address - Country:US
Mailing Address - Phone:860-728-6740
Mailing Address - Fax:860-547-1554
Practice Address - Street 1:224 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4763
Practice Address - Country:US
Practice Address - Phone:860-728-6740
Practice Address - Fax:860-547-1554
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030753207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D10030753CT01OtherANTHEM BCBS
D91440Medicare UPIN
CT200000519Medicare ID - Type Unspecified