Provider Demographics
NPI:1104865393
Name:KRUEGER, STEPHEN D (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 CARONDELET DR
Mailing Address - Street 2:SUITE 315
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4802
Mailing Address - Country:US
Mailing Address - Phone:816-942-3339
Mailing Address - Fax:816-942-0606
Practice Address - Street 1:1004 CARONDELET DR
Practice Address - Street 2:SUITE 315
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4802
Practice Address - Country:US
Practice Address - Phone:816-942-3339
Practice Address - Fax:816-942-0606
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4E91207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA624196Medicare ID - Type Unspecified
MOC50500Medicare UPIN