Provider Demographics
NPI:1033392170
Name:KRISTY K DAVIS DO PLLC
Entity Type:Organization
Organization Name:KRISTY K DAVIS DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SELF
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-251-1064
Mailing Address - Street 1:27100 MAHLE LANDING RD
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-9150
Mailing Address - Country:US
Mailing Address - Phone:269-251-1064
Mailing Address - Fax:
Practice Address - Street 1:916 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-2326
Practice Address - Country:US
Practice Address - Phone:269-251-1064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI111992060Medicaid
E33142Medicare UPIN
MIP53180001Medicare PIN
MI111992060Medicaid