Provider Demographics
NPI:1417931015
Name:KOLENDER, BRIAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:KOLENDER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5799 W MAPLE RD
Mailing Address - Street 2:SUITE 159
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4458
Mailing Address - Country:US
Mailing Address - Phone:248-737-0091
Mailing Address - Fax:248-737-0095
Practice Address - Street 1:5799 W MAPLE RD
Practice Address - Street 2:SUITE 159
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4458
Practice Address - Country:US
Practice Address - Phone:248-737-0091
Practice Address - Fax:248-737-0095
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2013-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301065408207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1417931015Medicaid
MI700H273300OtherBS OF MICHIGAN
MI06304821OtherBCBS INDIVIDUAL
MI110233802OtherRR MEDICARE
MIMI4989122Medicare PIN
MI1417931015Medicaid