KELLY M KRUEGER DO PLLC (NPI# 1144551805) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144551805 |
| Entity Type | Organization |
| Organization Name | KELLY M KRUEGER DO PLLC |
| Practice Address |
39555 W 10 Mile Rd Suite 305 Novi MI 48375-2950 |
| Practice Telephone | 2484267200 |
| Practice Fax Number | 5864267335 |
| Mailing Telephone | 2484267200 |
| Mailing Fax Number | 5864267335 |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2010-01-20 |
| Authorized Official Name | DR. KELLY M KRUEGER (OWNER) |
| Authorized Official Telephone | 2484267200 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 51010011317 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1487632014 | 05 | |
| MI | BCBS | 0856338164 | 01 |
| Street Address |
39555 W 10 MILE RD SUITE 305 |
| City | NOVI |
| State | MI |
| Zip Code | 48375-2950 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780666461 | Theodore William Shively | Family Medicine | 39555 W 10 Mile Rd, Suite 302, Novi, MI 48375-2950 | 2005-11-17 |
| 1265915748 | Lauren M Dunn | Registered Nurse | 39555 W 10 Mile Rd, Novi, MI 48375-2950 | 2018-09-11 |
| 1023421963 | Carla Ismail | Dentist | 39555 W 10 Mile Rd, Novi, MI 48375-2950 | 2014-06-09 |
| 1174875140 | Primecare Urgent Care Pllc | Clinic/Center | 39555 W 10 Mile Rd, Suite 301, Novi, MI 48375-2950 | 2012-10-15 |
| 1518272368 | Lisa Maroun | Dietitian, Registered | 39555 W 10 Mile Rd, Suite 302, Novi, MI 48375-2950 | 2010-08-17 |
| 1629237854 | Richard M Newman D.c. P.C. | Chiropractor | 39555 W 10 Mile Rd, #307, Novi, MI 48375-2950 | 2008-06-03 |
| 1972710945 | Michael P. Burk, D.p.m., Pllc | Podiatrist | 39555 W 10 Mile Rd, Suite 307, Novi, MI 48375-2950 | 2007-05-17 |
| 1053348359 | Michael Patrick Burk | Podiatrist | 39555 W 10 Mile Rd, Suite 307, Novi, MI 48375-2950 | 2006-06-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134747363 | Quick Care Medical Devices, LLC | Durable Medical Equipment & Medical Supplies | 25500 Meadowbrook Rd 275b, Novi, MI 48375 | 2020-07-14 |
| 1205475209 | Terri Lynn Tiederman | Registered Nurse | Cns Healthcare 24230 Karim Blvd, Ste 100, Novi, MI 48375 | 2019-12-23 |
| 1588202089 | Kenneth Alexander | Pharmacist | 40339 Grand River Ave # 110, Novi, MI 48375 | 2019-12-15 |
| 1962044644 | Sam Pharmacy Rx | Pharmacy | 39915 Grand River Ave Suite 550, Novi, MI 48375 | 2019-10-14 |
| 1700440203 | Arman C. Moshyedi, Md, Pllc | Psychiatry & Neurology | 4000 Grand River Avenue, Suite 306, Novi, MI 48375 | 2019-04-30 |
| 1225593726 | Daniel Woodward Mead | Nurse Practitioner | 39500 W 10 Mile Rd Ste 100, Novi, MI 48375 | 2019-02-08 |
| 1700340569 | Nuch of Michigan, Inc. | Clinic/Center | 20782 Thirteen Mile Road, Roseville, MI 48375 | 2019-01-25 |
| 1447735626 | Timothy Holland | Behavior Technician | 41521 W Ll Mile Rd, Novi, MI 48375 | 2018-10-03 |
| 1750874376 | Christian Field | Behavior Technician | 41512 W 11 Mile Rd, Novi, MI 48375 | 2018-06-08 |
| 1114415668 | O2 Pharmacy, LLC | Pharmacy | 39765 Grand River Ave, Novi, MI 48375 | 2018-04-30 |
| Find all providers in zip 48375 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992285118 | Jan Medical Inc | Family Medicine | 45686 S Lake Dr, Novi, MI 48377-3919 | 2018-08-16 |
| 1982103362 | Primecare On Wixom Pllc | Family Medicine | 27250 Wixom Rd Ste A, Novi, MI 48374-1116 | 2018-02-12 |
| 1326427105 | Paolo Nino Balmaseda | Family Medicine | 26750 Providence Pkwy Ste 210, Novi, MI 48374-1212 | 2015-05-26 |
| 1477811925 | Fallon Kapatais | Family Medicine | 40015 Grand River Ave Ste 100, Novi, MI 48375-2160 | 2012-05-02 |
| 1265727556 | Nicholas Jay Moore | Family Medicine | 26850 Providence Pkwy Ste 260, Novi, MI 48374-1256 | 2011-06-14 |
| 1023291390 | P & A of Farmington Hills, PC | Family Medicine | 44150 W 12 Mile Rd, Ste 100, Novi, MI 48377 | 2007-12-10 |
| 1962606350 | Progressive Medicine Pllc | Family Medicine | 47689 Aberdeen Dr, Novi, MI 48374-3690 | 2007-06-12 |
| 1235281916 | Primecare of Novi Pllc | Family Medicine | 39555 West Ten Mile Rd, Suite 302, Novi, MI 48375-2950 | 2007-01-16 |
| 1700942133 | Personal Care Physician Pllc | Family Medicine | 26179 Novi Rd, Novi, MI 48375-1140 | 2006-12-29 |
| 1679647200 | Robert Raja Zaid | Family Medicine | 39555 W 10 Mile Rd Ste 302, Novi, MI 48375-2950 | 2006-11-17 |
| Find all providers in NOVI | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.