Provider Demographics
NPI:1205022142
Name:MICHIGAN KIDNEY CARE PC
Entity Type:Organization
Organization Name:MICHIGAN KIDNEY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLAF
Authorized Official - Middle Name:C
Authorized Official - Last Name:KRONEMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:248-290-2940
Mailing Address - Street 1:1695 12 MILE RD
Mailing Address - Street 2:STE 250
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-2182
Mailing Address - Country:US
Mailing Address - Phone:248-414-3874
Mailing Address - Fax:248-646-7854
Practice Address - Street 1:1695 12 MILE RD
Practice Address - Street 2:STE 250
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-2182
Practice Address - Country:US
Practice Address - Phone:248-414-3874
Practice Address - Fax:248-646-7854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P01240Medicare PIN