Provider Demographics
NPI:1508894643
Name:DRENSER, KIMBERLY ALYSON (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ALYSON
Last Name:DRENSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:39650 ORCHARD HILL PL
Mailing Address - Street 2:200
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-5331
Mailing Address - Country:US
Mailing Address - Phone:248-319-0161
Mailing Address - Fax:248-319-0170
Practice Address - Street 1:3555 W 13 MILE RD
Practice Address - Street 2:LL-20
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6710
Practice Address - Country:US
Practice Address - Phone:248-288-2280
Practice Address - Fax:248-288-5644
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301081731207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H85452Medicare UPIN
0Q26082036Medicare PIN
MI1508894643Medicaid
0M21980022Medicare PIN
MI38-1946761OtherGRP TAX ID #
MI4740405Medicaid
MI4740414Medicaid
MI4749661Medicaid
0M21980022Medicare PIN