MEDICARE: DR. GLENN KRIEGER & ASSOCIATES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	B3480C	MI

General Provider Information

NPI Number	:	1386866135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. GLENN KRIEGER & ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	6450 FARMINGTON RD
Second Line	:	SUITE 105
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4455
Country	:	US
Telephone Number	:	248-661-0100
Fax Number	:	248-661-5385

Provider Business Practice Location Address
First Line	:	6450 FARMINGTON RD
Second Line	:	SUITE 105
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4455
Country	:	US
Telephone Number	:	248-661-0100
Fax Number	:	248-661-5385

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GLENN D KRIEGER
Credential	:	M.D.
Telephone Number	:	248-661-0100

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	08/22/2020

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