Individual
MICHAEL STEPHAN KRUEGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
501 SE 172ND AVE, VANCOUVER, WA 98684
(360) 882-2778
(360) 604-1723
Mailing address
700 NE 87TH AVE, VANCOUVER, WA 98664-1913
(360) 254-1240
(360) 397-3128
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10004647
WA
363AM0700X
Medical Physician Assistant
PA01022
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8486540
—
WA
Enumeration date
07/25/2006
Last updated
08/05/2018
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