| Kelly M Krueger Do Pllc | |
|
39555 W 10 Mile Rd Suite 305 Novi MI 48375-2950 | |
| (248) 426-7200 | |
| (586) 426-7335 |
| Full Name | Kelly M Krueger Do Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 39555 W 10 Mile Rd, Novi, Michigan |
| Authorized Official Name and Position | Kelly M Krueger (OWNER) |
| Authorized Official Contact | 2484267200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly M Krueger Do Pllc 39555 W 10 Mile Rd Suite 305 Novi MI 48375-2950 Ph: (248) 426-7200 | Kelly M Krueger Do Pllc 39555 W 10 Mile Rd Suite 305 Novi MI 48375-2950 Ph: (248) 426-7200 |
| NPI Number | 1144551805 |
|---|---|
| Provider Enumeration Date | 01/20/2010 |
| Last Update Date | 01/20/2010 |
| Medicare PECOS PAC ID | 8325176191 |
|---|---|
| Medicare Enrollment ID | O20100514000834 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144551805 | NPI | - | NPPES |
| 1487632014 | Medicaid | MI | |
| 0856338164 | Other | MI | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 51010011317 (Michigan) | Primary |
| Provider Name | Kelly M Krueger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487632014 PECOS PAC ID: 9436127339 Enrollment ID: I20040920000147 |
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