Healthcare Provider Details

I. General information

NPI: 1679530810
Provider Name (Legal Business Name): DANIEL RAYMOND KROEGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4371 FERGUSON DR
CINCINNATI OH
45245-1668
US

IV. Provider business mailing address

4371 FERGUSON DRIVE
CINCINNATI OH
45245-1668
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-3650
  • Fax: 513-752-3387
Mailing address:
  • Phone: 513-752-3650
  • Fax: 513-752-3387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-05-9282
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: