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General NPI Number Information
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NPI Number | 1497784862
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Entity Type | Individual
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Provider Name | RICHARD C KRUEGER JR. M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 2836 W 98TH PL
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2613
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Country | US
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Telephone | 505-506-1090
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Fax | 888-734-8467
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Provider Business Mailing Address
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Address Line | 712 GENEVA ST
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City | GLENDALE
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State | CA
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Zip | 91206-2122
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Country | US
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Telephone | 505-506-1090
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Fax | 888-734-8467
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | MD2006-0698
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 036.084830
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | MD 60132358
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 01069425A
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License Number State | IN
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Taxonomy #5
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 28859
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License Number State | OK
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Taxonomy #6
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 2012003667
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License Number State | MO
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Taxonomy #7
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 21987
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License Number State | MS
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Taxonomy #8
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | G85014
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License Number State | CA
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