Provider Demographics
NPI:1629043815
Name:MISHACK, KRISZTINA ZEHIDA (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISZTINA
Middle Name:ZEHIDA
Last Name:MISHACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1135 W UNIVERSITY DR
Mailing Address - Street 2:SUITE 425
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1871
Mailing Address - Country:US
Mailing Address - Phone:248-650-5861
Mailing Address - Fax:248-650-5865
Practice Address - Street 1:1135 W UNIVERSITY DR
Practice Address - Street 2:SUITE 425
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1871
Practice Address - Country:US
Practice Address - Phone:248-650-5861
Practice Address - Fax:248-650-5865
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062365208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4448247Medicaid
MI4448247Medicaid
MIH55359Medicare UPIN