Healthcare Provider Details

I. General information

NPI: 1104128438
Provider Name (Legal Business Name): MYLES K. KRIEGER, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4340 SHERIDAN ST SUITE #202
HOLLYWOOD FL
33021-3567
US

IV. Provider business mailing address

4340 SHERIDAN ST SUITE #202
HOLLYWOOD FL
33021-3567
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberME26172
License Number StateFL

VIII. Authorized Official

Name: ANA CAMPOS
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 954-963-3222