Basic Information
| Provider Information | |||||||||
| NPI: | 1689677866 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KROEGER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 S 90TH ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681143907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023979800 | ||||||||
| FaxNumber: | 4023977591 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 S 90TH ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681143907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023979800 | ||||||||
| FaxNumber: | 4023977591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 10/10/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 15295 | NE | Y | Allopathic & Osteopathic Physicians | Urology | 208800000X | 25983 | IA | N | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 0983973 | 05 | IA | MEDICAID |