Kelly M Krueger DO PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

51010011317 Issued in MI

Legal business name

KELLY M KRUEGER DO PLLC

Practice address

39555 W 10 Mile Rd
Suite 305
Novi, MI 48375-2950

Phone

(248) 426-7200

Fax

(586) 426-7335

NPI assigned

Jan 20, 2010

Last updated

Jan 20, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kelly M Krueger, DONPI 1487632014

Title

Owner

Phone

(248) 426-7200

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelly M Krueger, D.O.

  • Family Medicine Physician
  • Novi, MI
  • NPI 1487632014
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263945600000",
    "number": "1144551805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39555 W 10 MILE RD",
            "address_2": "SUITE 305",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483752950",
            "telephone_number": "248-426-7200",
            "fax_number": "586-426-7335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39555 W 10 MILE RD",
            "address_2": "SUITE 305",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483752950",
            "telephone_number": "248-426-7200",
            "fax_number": "586-426-7335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY M KRUEGER DO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-20",
        "last_updated": "2010-01-20",
        "status": "A",
        "authorized_official_last_name": "KRUEGER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-426-7200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "51010011317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1487632014",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0856338164",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Keller
• Tiffany Keller
• Lindsy Kelley
• Pamela Kelley
• Theresa Kelley
• April Kelly
• Cheyanne Kelly
• Joanne Kelly
• Kathleen Kelly
• Kinkead Kelly

• Family Medicine Physician in Novi, MI
• Providers in Novi, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.