MEDICARE: MARGIE KRUEGER

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	2471R0002X	Radiation Therapy Radiologic Technologist	178012	WI

General Provider Information

NPI Number	:	1962804526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGIE KRUEGER

Provider Business Mailing Address
First Line	:	5000 W NATIONAL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53295-0001
Country	:	US
Telephone Number	:	414-384-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4748 S 47TH ST
Second Line	:
City	:	GREENFIELD
State	:	WI
Zip	:	53220-4802
Country	:	US
Telephone Number	:	414-282-7891
Fax Number	:

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

Provider Enumeration Date	:	09/25/2014
Last Update Date	:	09/25/2014

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