Provider Demographics
NPI:1114921095
Name:WOODARD, KRISTIN E (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:E
Last Name:WOODARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7640 SYLVANIA AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9729
Mailing Address - Country:US
Mailing Address - Phone:419-517-1001
Mailing Address - Fax:419-517-1021
Practice Address - Street 1:7640 SYLVANIA AVE
Practice Address - Street 2:SUITE K
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9729
Practice Address - Country:US
Practice Address - Phone:419-517-1001
Practice Address - Fax:419-517-1021
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-5713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00038728OtherRAILROAD MEDICARE
OH2420633Medicaid
MI4524124Medicaid
OH2420633Medicaid
OHWO4107201Medicare PIN