Provider Demographics
NPI:1912069766
Name:MICHAEL B KRONENBERGER. MD, PA
Entity Type:Organization
Organization Name:MICHAEL B KRONENBERGER. MD, PA
Other - Org Name:EAR, NOSE & THROAT SPECIALTY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-826-3681
Mailing Address - Street 1:411 N WASHINGTON AVE STE 7000
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1791
Mailing Address - Country:US
Mailing Address - Phone:214-826-3681
Mailing Address - Fax:214-826-7277
Practice Address - Street 1:411 N WASHINGTON AVE STE 7000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1791
Practice Address - Country:US
Practice Address - Phone:214-826-3681
Practice Address - Fax:214-826-7277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00467YMedicare ID - Type Unspecified