Provider Demographics
NPI:1508931213
Name:DUFFY, KRISTINE MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:MARY
Last Name:DUFFY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N WIXOM RD
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-2161
Mailing Address - Country:US
Mailing Address - Phone:248-669-1009
Mailing Address - Fax:248-669-6229
Practice Address - Street 1:120 N WIXOM RD
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-2161
Practice Address - Country:US
Practice Address - Phone:248-669-1009
Practice Address - Fax:248-669-6229
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044930207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0632785Medicare ID - Type Unspecified
B42898Medicare UPIN