Provider Demographics
NPI:1093904864
Name:ALAINA KRONENBERG, M.D.,PLC
Entity Type:Organization
Organization Name:ALAINA KRONENBERG, M.D.,PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KRONENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-582-8856
Mailing Address - Street 1:15212 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3497
Mailing Address - Country:US
Mailing Address - Phone:313-582-8856
Mailing Address - Fax:313-582-8265
Practice Address - Street 1:15212 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3497
Practice Address - Country:US
Practice Address - Phone:313-582-8856
Practice Address - Fax:313-582-8265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAK076661207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI48195888Medicaid
MI48195888Medicaid
MIL04761Medicare UPIN