Provider Demographics
NPI:1356863005
Name:STEPHEN KRONBERG MD PC
Entity Type:Organization
Organization Name:STEPHEN KRONBERG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRONBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-478-1100
Mailing Address - Street 1:14237 FENTON
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-2878
Mailing Address - Country:US
Mailing Address - Phone:313-310-5337
Mailing Address - Fax:
Practice Address - Street 1:20331 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1411
Practice Address - Country:US
Practice Address - Phone:248-478-1100
Practice Address - Fax:248-478-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-14
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISK058204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4535585Medicaid
MI4301058204OtherSTATE LICENSE