Healthcare Provider Details

I. General information

NPI: 1003929217
Provider Name (Legal Business Name): SAMUEL B KRIEGLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 LORETTO RD
LEBANON KY
40033-1628
US

IV. Provider business mailing address

420 LORETTO RD
LEBANON KY
40033-1628
US

V. Phone/Fax

Practice location:
  • Phone: 270-692-5139
  • Fax: 270-699-4628
Mailing address:
  • Phone: 270-692-5139
  • Fax: 270-699-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number46375
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: