Provider Demographics
NPI:1316938061
Name:KRONEMAN, OLAF C III (MD)
Entity type:Individual
Prefix:DR
First Name:OLAF
Middle Name:C
Last Name:KRONEMAN
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:1695 W 12 MILE RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-2182
Mailing Address - Country:US
Mailing Address - Phone:248-414-3874
Mailing Address - Fax:248-646-7854
Practice Address - Street 1:1695 W 12 MILE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-2182
Practice Address - Country:US
Practice Address - Phone:248-414-3874
Practice Address - Fax:248-646-7854
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2013-07-09
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Provider Licenses
StateLicense IDTaxonomies
MI4301045888207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0678566Medicaid
MI0678566Medicaid
B47534Medicare UPIN