Healthcare Provider Details

I. General information

NPI: 1427013184
Provider Name (Legal Business Name): DUANE E KREIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22074 MICHIGAN AVE
DEARBORN MI
48124-2353
US

IV. Provider business mailing address

5029 VILLAGE SQUARE CT
W BLOOMFIELD MI
48322-3379
US

V. Phone/Fax

Practice location:
  • Phone: 313-565-9510
  • Fax: 313-565-4410
Mailing address:
  • Phone: 248-788-3761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberDK058272
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: