Provider Demographics
NPI:1427013184
Name:KREIL, DUANE E (MD)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:E
Last Name:KREIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5029 VILLAGE SQUARE CT
Mailing Address - Street 2:
Mailing Address - City:W BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3379
Mailing Address - Country:US
Mailing Address - Phone:248-788-3761
Mailing Address - Fax:
Practice Address - Street 1:22074 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2353
Practice Address - Country:US
Practice Address - Phone:313-565-9510
Practice Address - Fax:313-565-4410
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDK058272207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI015098OtherMIDWEST HEALTH PLANS
MI125116OtherCARE CHOICES
MIP87561OtherBCN
MI47526OtherOMNICARE HEALTH PLAN
MI4312641Medicaid
MI4363533Medicaid
MI5338131OtherAETNA
MIG08062OtherHAP
MI160H261380OtherBCBSM/BCN
MI125116OtherCARE CHOICES
MI160H261380OtherBCBSM/BCN