Provider Demographics
NPI:1417574831
Name:KREUTZ, KASEY (MD)
Entity type:Individual
Prefix:DR
First Name:KASEY
Middle Name:
Last Name:KREUTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 NORTHSIDE HIGH SCHOOL RD # 200
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019
Mailing Address - Country:US
Mailing Address - Phone:540-561-6600
Mailing Address - Fax:
Practice Address - Street 1:6600 NORTHSIDE HIGHSCHOOL RD #200
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019
Practice Address - Country:US
Practice Address - Phone:540-561-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101280364207ZP0101X
MO2020015732207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty