Provider Demographics
NPI:1629000930
Name:JOHN KOLSTOE MD PLLC
Entity Type:Organization
Organization Name:JOHN KOLSTOE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KOLSTOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-351-9386
Mailing Address - Street 1:1401 E LANSING DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-7787
Mailing Address - Country:US
Mailing Address - Phone:517-351-9386
Mailing Address - Fax:517-351-9388
Practice Address - Street 1:1401 E LANSING DR
Practice Address - Street 2:SUITE 108
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-7787
Practice Address - Country:US
Practice Address - Phone:517-351-9386
Practice Address - Fax:517-351-9388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301046998207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P33710Medicare PIN
MIA79296Medicare UPIN