Organization
KELLY M KRUEGER DO PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY M KRUEGER DO (OWNER)
(248) 426-7200
Entity
Organization
Contact information
Practice address
39555 W 10 MILE RD, SUITE 305, NOVI, MI 48375-2950
(248) 426-7200
(586) 426-7335
Mailing address
39555 W 10 MILE RD, SUITE 305, NOVI, MI 48375-2950
(248) 426-7200
(586) 426-7335
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
51010011317
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0856338164
BCBS
MI
05
—
1487632014
—
MI
Enumeration date
01/20/2010
Last updated
01/20/2010
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