Provider Demographics
NPI:1275824641
Name:ZITELLI, KRISTINE BUSSE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:BUSSE
Last Name:ZITELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:LYNNE
Other - Last Name:BUSSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5298 SOCIALVILLE FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9302
Mailing Address - Country:US
Mailing Address - Phone:513-770-4212
Mailing Address - Fax:513-770-4213
Practice Address - Street 1:5298 SOCIALVILLE FOSTER RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9302
Practice Address - Country:US
Practice Address - Phone:513-770-4212
Practice Address - Fax:513-770-4213
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.125434207N00000X
OH57.019687207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0101741Medicaid
OHH406600Medicare PIN