Healthcare Provider Details

I. General information

NPI: 1538159231
Provider Name (Legal Business Name): KENNETH J KRUEGER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15022 SULLIVAN LN
WESTFIELD IN
46074-9802
US

IV. Provider business mailing address

15022 SULLIVAN LN
WESTFIELD IN
46074-9802
US

V. Phone/Fax

Practice location:
  • Phone: 317-713-1111
  • Fax: 317-713-1100
Mailing address:
  • Phone: 317-713-1111
  • Fax: 317-713-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000391A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: