Individual
ELLEN MARIE KRUGGEL
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4600 BRETON RD SE, SUITE 103, KENTWOOD, MI 49508-5262
(616) 656-8600
(616) 656-8601
Mailing address
4600 BRETON RD SE, SUITE 103, KENTWOOD, MI 49508-5262
(616) 656-8600
(616) 656-8601
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301067448
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4695097
—
MI
Enumeration date
10/28/2005
Last updated
07/08/2007
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