MEDICARE: DR. RICHARD C KRUEGER JR. M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080N0001X	Neonatal-Perinatal Medicine Physician	MD2006-0698	NM
2	2080N0001X	Neonatal-Perinatal Medicine Physician	036.084830	IL
3	2080N0001X	Neonatal-Perinatal Medicine Physician	MD 60132358	WA
4	2080N0001X	Neonatal-Perinatal Medicine Physician	01069425A	IN
5	2080N0001X	Neonatal-Perinatal Medicine Physician	28859	OK
6	2080N0001X	Neonatal-Perinatal Medicine Physician	2012003667	MO
7	2080N0001X	Neonatal-Perinatal Medicine Physician	21987	MS
8	2080N0001X	Neonatal-Perinatal Medicine Physician	G85014	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000745199	OTHER	IN	ANTHEM PROVIDER NUMBER

General Provider Information

NPI Number	:	1497784862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD C KRUEGER JR. M.D., PH.D.

Provider Business Mailing Address
First Line	:	712 GENEVA ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-2122
Country	:	US
Telephone Number	:	505-506-1090
Fax Number	:	888-734-8467

Provider Business Practice Location Address
First Line	:	2836 W 98TH PL
Second Line	:
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-2613
Country	:	US
Telephone Number	:	505-506-1090
Fax Number	:	888-734-8467

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	09/20/2022

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Directions to “ DR. RICHARD C KRUEGER JR. M.D., PH.D.” Practice Location

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