Provider Demographics
NPI:1033171871
Name:MASUGA, KRISTINA LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:LYNNE
Last Name:MASUGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10409 S RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-8616
Mailing Address - Country:US
Mailing Address - Phone:906-203-5848
Mailing Address - Fax:
Practice Address - Street 1:10409 S RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-8616
Practice Address - Country:US
Practice Address - Phone:906-203-5848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063737207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315054007OtherCONTROLLED SUBSTANCE LICENSE
FP3496672OtherDEA