Provider Demographics
NPI:1093806895
Name:DIANE KRIEGER, MD
Entity Type:Organization
Organization Name:DIANE KRIEGER, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIEGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-665-2300
Mailing Address - Street 1:6280 SUNSET DRIVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143
Mailing Address - Country:US
Mailing Address - Phone:305-665-2300
Mailing Address - Fax:
Practice Address - Street 1:6141 SUNSET DR STE 403
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5026
Practice Address - Country:US
Practice Address - Phone:305-665-2300
Practice Address - Fax:305-669-8966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2095Medicare ID - Type Unspecified