Provider Demographics
NPI:1831176478
Name:MILLER-UNGER, KIRSTEN MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:MICHELLE
Last Name:MILLER-UNGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57222 BRECKENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-3577
Mailing Address - Country:US
Mailing Address - Phone:586-480-3895
Mailing Address - Fax:
Practice Address - Street 1:36555 26 MILE RD STE 2100
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MI
Practice Address - Zip Code:48048-3188
Practice Address - Country:US
Practice Address - Phone:586-532-0599
Practice Address - Fax:586-566-8967
Is Sole Proprietor?:No
Enumeration Date:2005-12-26
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078011208000000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4764050Medicaid
MI383577242OtherSHARED TAX ID