Provider Demographics
NPI:1619358793
Name:WIXON, KRISTINA MARIA (DO)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIA
Last Name:WIXON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:27450 SCHOENHERR RD STE 400
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6684
Mailing Address - Country:US
Mailing Address - Phone:586-582-7550
Mailing Address - Fax:586-582-7515
Practice Address - Street 1:6000 24 MILE RD
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48316-3201
Practice Address - Country:US
Practice Address - Phone:586-677-3310
Practice Address - Fax:586-677-3326
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2018-06-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101021985207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine