Provider Demographics
NPI:1366416539
Name:KREUSER, STEPHEN ROBERT (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ROBERT
Last Name:KREUSER
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 1:320 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:WASHBURN
Mailing Address - State:WI
Mailing Address - Zip Code:54891
Mailing Address - Country:US
Mailing Address - Phone:715-373-0128
Mailing Address - Fax:715-373-0135
Practice Address - Street 1:320 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:WASHBURN
Practice Address - State:WI
Practice Address - Zip Code:54891
Practice Address - Country:US
Practice Address - Phone:715-373-0128
Practice Address - Fax:715-373-0135
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26675020208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1992095970Medicaid