Provider Demographics
NPI:1104128438
Name:MYLES K. KRIEGER, M.D., P.A.
Entity type:Organization
Organization Name:MYLES K. KRIEGER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-963-3222
Mailing Address - Street 1:4340 SHERIDAN ST
Mailing Address - Street 2:SUITE #202
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3567
Mailing Address - Country:US
Mailing Address - Phone:954-963-3222
Mailing Address - Fax:
Practice Address - Street 1:4340 SHERIDAN ST
Practice Address - Street 2:SUITE #202
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3567
Practice Address - Country:US
Practice Address - Phone:954-963-3222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26172207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME26172OtherSTATE LICENSE NUMBER
FLME26172OtherSTATE LICENSE NUMBER
FL93405Medicare PIN