Healthcare Provider Details

I. General information

NPI: 1679219786
Provider Name (Legal Business Name): CHRISTOPHER JACK KRUGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4260 PLYMOUTH RD
ANN ARBOR MI
48109-2700
US

IV. Provider business mailing address

1540 E HOSPITAL DR
ANN ARBOR MI
48109-4000
US

V. Phone/Fax

Practice location:
  • Phone: 734-539-5080
  • Fax:
Mailing address:
  • Phone: 734-647-1774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301513885
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: