Healthcare Provider Details

I. General information

NPI: 1396714937
Provider Name (Legal Business Name): MICHAEL L KRUEGER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7033 N FRESNO ST STE 301
FRESNO CA
93720
US

IV. Provider business mailing address

7033 N FRESNO ST STE 301
FRESNO CA
93720
US

V. Phone/Fax

Practice location:
  • Phone: 559-438-8181
  • Fax: 559-438-8179
Mailing address:
  • Phone: 559-438-8181
  • Fax: 559-438-8179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number020A67600
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: