Provider Demographics
NPI:1073721320
Name:KIENINGER, ALICIA NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:NICOLE
Last Name:KIENINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44555 WOODWARD AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5031
Mailing Address - Country:US
Mailing Address - Phone:248-338-7171
Mailing Address - Fax:248-858-3889
Practice Address - Street 1:44555 WOODWARD AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5031
Practice Address - Country:US
Practice Address - Phone:248-338-7171
Practice Address - Fax:248-858-3889
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077660208600000X
MO2009010047208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$Medicaid
101740026Medicare PIN