MEDICARE: KORI K KRUEGER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	42467	WI
2	207R00000X	Internal Medicine Physician	42467	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760582134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KORI K KRUEGER MD

Provider Business Mailing Address
First Line	:	1000 N OAK AVE
Second Line	:
City	:	MARSHFIELD
State	:	WI
Zip	:	54449-5703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S WISCONSIN AVE
Second Line	:
City	:	STRATFORD
State	:	WI
Zip	:	54484-9692
Country	:	US
Telephone Number	:	715-687-4211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	10/26/2020

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