Healthcare Provider Details

I. General information

NPI: 1508894643
Provider Name (Legal Business Name): KIMBERLY ALYSON DRENSER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 W 13 MILE RD LL-20
ROYAL OAK MI
48073-6710
US

IV. Provider business mailing address

39650 ORCHARD HILL PL 200
NOVI MI
48375-5331
US

V. Phone/Fax

Practice location:
  • Phone: 248-288-2280
  • Fax: 248-288-5644
Mailing address:
  • Phone: 248-319-0161
  • Fax: 248-319-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301081731
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number4301081731
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: