Provider Demographics
NPI:1750509691
Name:KRANNITZ, KRISTOPHER W (DPM)
Entity Type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:W
Last Name:KRANNITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8805 PINE RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601
Mailing Address - Country:US
Mailing Address - Phone:231-779-3668
Mailing Address - Fax:231-779-4496
Practice Address - Street 1:8805 PINE RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2373
Practice Address - Country:US
Practice Address - Phone:231-779-3668
Practice Address - Fax:231-779-4496
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002174213E00000X, 213ER0200X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4858317570OtherBLUE CROSS
MI5175073Medicaid
MI5175055Medicaid
MI144901OtherPRIORITY HEALTH
MIP00398712Medicare PIN
MI5175073Medicaid