Provider Demographics
NPI:1326120023
Name:BEHRENS, KIMBERLEY GRETCHEN (MD)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:GRETCHEN
Last Name:BEHRENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:GRETCHEN
Other - Last Name:CRONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6330 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2398
Mailing Address - Country:US
Mailing Address - Phone:248-855-3366
Mailing Address - Fax:248-855-6213
Practice Address - Street 1:6330 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2398
Practice Address - Country:US
Practice Address - Phone:248-855-3366
Practice Address - Fax:248-855-6213
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35095061207ZD0900X
MO2006001766207ZP0102X
MI4301091039207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1326120023Medicaid