Basic Information
Provider Information | |||||||||
NPI: | 1356554976 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KRIEGEL | ||||||||
FirstName: | SVETLANA | ||||||||
MiddleName: | IGOREVNA | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | KRASSILNIKOVA | ||||||||
OtherFirstName: | SVETLANA | ||||||||
OtherMiddleName: | IGOREVNA | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 3355 GLENDALE AVE FL 3 | ||||||||
Address2: |   | ||||||||
City: | TOLEDO | ||||||||
State: | OH | ||||||||
PostalCode: | 436142426 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4193833780 | ||||||||
FaxNumber: | 4193833269 | ||||||||
Practice Location | |||||||||
Address1: | 3125 TRANSVERSE DR | ||||||||
Address2: | RUPPERT HEALTH CENTER | ||||||||
City: | TOLEDO | ||||||||
State: | OH | ||||||||
PostalCode: | 436148008 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4193833780 | ||||||||
FaxNumber: | 4193833269 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/08/2007 | ||||||||
LastUpdateDate: | 01/02/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0201X | 35.129469 | OH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Allergy & Immunology | 207K00000X | 0101245901 | VA | N |   | Allopathic & Osteopathic Physicians | Allergy & Immunology |   |
ID Information
ID | Type | State | Issuer | Description | 0180977 | 05 | OH |   | MEDICAID |