Provider Demographics
NPI:1710959127
Name:LEDBETTER, KRISTI J (DPM)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:J
Last Name:LEDBETTER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:
Other - Last Name:SHRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2797 SPRING ARBOR RD
Mailing Address - Street 2:STE. A
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3605
Mailing Address - Country:US
Mailing Address - Phone:517-784-0900
Mailing Address - Fax:517-784-7835
Practice Address - Street 1:2797 SPRING ARBOR RD
Practice Address - Street 2:STE. A
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3605
Practice Address - Country:US
Practice Address - Phone:517-784-0900
Practice Address - Fax:517-784-7835
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKL002092213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114527OtherAETNA
MI1710959127Medicaid
MI36740OtherHEALTH PLAN OF MICHIGAN
MI48-5-81-1491-0OtherBCBS
MIP00739357OtherRAILROAD MEDICARE
MIP00739357OtherRAILROAD MEDICARE