Provider Demographics
NPI:1386866135
Name:DR. GLENN KRIEGER & ASSOCIATES PLLC
Entity Type:Organization
Organization Name:DR. GLENN KRIEGER & ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KRIEGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-661-0100
Mailing Address - Street 1:6450 FARMINGTON RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4455
Mailing Address - Country:US
Mailing Address - Phone:248-661-0100
Mailing Address - Fax:248-661-5385
Practice Address - Street 1:6450 FARMINGTON RD
Practice Address - Street 2:SUITE 105
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4455
Practice Address - Country:US
Practice Address - Phone:248-661-0100
Practice Address - Fax:248-661-5385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIB3480C261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty