Healthcare Provider Details

I. General information

NPI: 1073721320
Provider Name (Legal Business Name): ALICIA NICOLE KIENINGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 DIXIE HWY SUITE 202
CLARKSTON MI
48346
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DRIVE SUITE J2000
ANN ARBOR MI
48105
US

V. Phone/Fax

Practice location:
  • Phone: 248-338-7171
  • Fax: 248-858-3889
Mailing address:
  • Phone: 734-747-6768
  • Fax: 734-222-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301077660
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number4301077660
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: