Active NPI
Keith Kenneth Krueger, M.D.
- Family Medicine Physician
- Roseville, MN
National Provider Identifier
1023185352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 36594
- Practice address
- 2336 Lexington Ave N
Roseville, MN 55113-4343 - Phone
- (651) 631-0065
- Fax
- (651) 631-0096
- NPI assigned
- Nov 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 36594 | MN | Primary |
Addresses
Primary practice location
2336 Lexington Ave N
Roseville, MN 55113-4343
Mailing address
1301 47TH St SE
Saint Cloud, MN 56304-9515
Phone (320) 240-8161
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130809000099 | MN | Order and Referring Only - Family Practice | 4284876913 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023185352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1301 47TH ST SE",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563049515",
"telephone_number": "320-240-8161",
"fax_number": "651-631-0096"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2336 LEXINGTON AVE N",
"city": "ROSEVILLE",
"state": "MN",
"postal_code": "551134343",
"telephone_number": "651-631-0065",
"fax_number": "651-631-0096"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUEGER",
"first_name": "KEITH",
"middle_name": "KENNETH",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "36594",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.