Provider Demographics
NPI:1376720490
Name:BAXMAN, KRISTIN NOEL (RT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:NOEL
Last Name:BAXMAN
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:27207 LAHSER RD
Mailing Address - Street 2:STE 200B
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-2168
Mailing Address - Country:US
Mailing Address - Phone:248-663-1900
Mailing Address - Fax:248-663-1902
Practice Address - Street 1:27207 LAHSER RD
Practice Address - Street 2:STE 200B
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-2168
Practice Address - Country:US
Practice Address - Phone:248-663-1900
Practice Address - Fax:248-663-1902
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M08420Medicare UPIN