=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013595750
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNN KRIENGKRAIRUT MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2021
-----------------------------------------------------
Last Update Date | 01/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 N MAIN ST
-----------------------------------------------------
City | CHELSEA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48118-1370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-433-1500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3514 NOBLE DR
-----------------------------------------------------
City | DEXTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48130-9201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-226-0968
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 4301513054
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------