MEDICARE: DR. GLENN KRIEGER M.D.

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	208100000X	Physical Medicine & Rehabilitation Physician	GK053922	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528018827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN KRIEGER M.D.

Provider Business Mailing Address
First Line	:	147 N HAVEN ST
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48377-1316
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/08/2007

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