Individual
KENNETH J KRUEGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
4725 STATESMEN DR STE A, INDIANAPOLIS, IN 46250-5645
(317) 713-1111
(317) 713-1100
Mailing address
4725 STATESMEN DR STE A, INDIANAPOLIS, IN 46250-5645
(317) 713-1111
(317) 713-1100
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07000391A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000344455
ANTHEM BLUE CROSS AND BLUE SHIELD
IN
05
—
100060080
—
IN
Enumeration date
10/24/2005
Last updated
04/05/2018
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