Healthcare Provider Details

I. General information

NPI: 1326120023
Provider Name (Legal Business Name): KIMBERLEY GRETCHEN BEHRENS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLEY GRETCHEN CRONE M.D.

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 ORCHARD LAKE RD SUITE 120
WEST BLOOMFIELD MI
48322-2398
US

IV. Provider business mailing address

6330 ORCHARD LAKE RD SUITE 120
WEST BLOOMFIELD MI
48322-2398
US

V. Phone/Fax

Practice location:
  • Phone: 248-855-3366
  • Fax: 248-855-6213
Mailing address:
  • Phone: 248-855-3366
  • Fax: 248-855-6213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number35095061
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2006001766
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number4301091039
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: