Provider Demographics
NPI:1235441528
Name:BECKHOLT, KRISTY ANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:ANNE
Last Name:BECKHOLT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:ANNE
Other - Last Name:SNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1215 E. MICHIGAN AVE 7TH FL TOWER WEST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912
Mailing Address - Country:US
Mailing Address - Phone:517-364-3380
Mailing Address - Fax:517-364-3399
Practice Address - Street 1:1215 E MICHIGAN AVE 7TH FL TOWER WEST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912
Practice Address - Country:US
Practice Address - Phone:517-364-3380
Practice Address - Fax:517-364-3399
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018602207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1235441528Medicaid
MI5330585OtherBCBS PIN
MI5330585OtherBCBS PIN