Healthcare Provider Details

I. General information

NPI: 1831190180
Provider Name (Legal Business Name): MYLES KEITH KRIEGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 SHERIDAN ST SUITE 101
HOLLYWOOD FL
33021-3556
US

IV. Provider business mailing address

4350 SHERIDAN ST SUITE 101
HOLLYWOOD FL
33021-3556
US

V. Phone/Fax

Practice location:
  • Phone: 954-963-3222
  • Fax: 954-963-1471
Mailing address:
  • Phone: 954-963-3222
  • Fax: 954-963-1471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberME26172
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: