Provider Demographics
NPI:1831190180
Name:KRIEGER, MYLES KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:MYLES
Middle Name:KEITH
Last Name:KRIEGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4350 SHERIDAN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3556
Mailing Address - Country:US
Mailing Address - Phone:954-963-3222
Mailing Address - Fax:954-963-1471
Practice Address - Street 1:4350 SHERIDAN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3556
Practice Address - Country:US
Practice Address - Phone:954-963-3222
Practice Address - Fax:954-963-1471
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2015-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME26172204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME26172OtherSTATE LICENSE NUMBER
FL93405ZOtherPTAN
FL93405ZOtherPTAN