Provider Demographics
NPI:1760777015
Name:MCWILLIAMS, KRISTINE RENEE FORTIN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:RENEE FORTIN
Last Name:MCWILLIAMS
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:MS
Other - First Name:KRISTINE
Other - Middle Name:RENEE
Other - Last Name:FORTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 LONGMAN LN
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-4028
Mailing Address - Country:US
Mailing Address - Phone:267-972-9242
Mailing Address - Fax:
Practice Address - Street 1:5333 MCAULEY DR., SUITE 4001
Practice Address - Street 2:ACADEMIC INTERNAL MEDICINE
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8633
Practice Address - Country:US
Practice Address - Phone:734-712-3980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program