Active NPI
Michigan Kidney Care PC
- Nephrology Physician
- Berkley, MI
National Provider Identifier
1205022142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- Legal business name
- MICHIGAN KIDNEY CARE PC
- Practice address
- 1695 12 Mile Rd
Ste 250
Berkley, MI 48072-2182 - Phone
- (248) 414-3874
- Fax
- (248) 646-7854
- NPI assigned
- Sep 24, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Olaf C Kroneman III, MD
- Title
- Owner
- Phone
- (248) 290-2940
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | Primary |
Addresses
Primary practice location
1695 12 Mile Rd
Ste 250
Berkley, MI 48072-2182
Mailing address
1695 12 Mile Rd
Ste 250
Berkley, MI 48072-2182
Phone (248) 414-3874
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041026000499 | MI | Part B Supplier - Clinic/Group Practice | 4284695883 |
Receives reassigned benefits from 2 practitioners Practice locations: Berkley, MI; Pontiac, MI; Royal Oak, MI; Troy, MI |
National Provider Directory
National Provider DirectoryLocations
1695 12 Mile Rd
Ste 250
Berkley, MI 48072
Phone (248) 414-3874
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190592000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1210723200000",
"number": "1205022142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1695 12 MILE RD",
"address_2": "STE 250",
"city": "BERKLEY",
"state": "MI",
"postal_code": "480722182",
"telephone_number": "248-414-3874",
"fax_number": "248-646-7854"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1695 12 MILE RD",
"address_2": "STE 250",
"city": "BERKLEY",
"state": "MI",
"postal_code": "480722182",
"telephone_number": "248-414-3874",
"fax_number": "248-646-7854"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MICHIGAN KIDNEY CARE PC",
"organizational_subpart": "NO",
"enumeration_date": "2007-09-24",
"last_updated": "2008-05-14",
"status": "A",
"authorized_official_last_name": "KRONEMAN",
"authorized_official_first_name": "OLAF",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "248-290-2940",
"authorized_official_name_prefix": "Dr.",
"authorized_official_name_suffix": "III",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Nephrology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkley, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; 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.