Provider Demographics
NPI:1851318216
Name:HODNE, KRISTA (MD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:HODNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 E HURON RIVER DR
Mailing Address - Street 2:MC 69504
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1051
Mailing Address - Country:US
Mailing Address - Phone:734-827-8883
Mailing Address - Fax:734-827-8915
Practice Address - Street 1:119 WATERSTRADT COMMERCE DR
Practice Address - Street 2:SUITE #1
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131-9695
Practice Address - Country:US
Practice Address - Phone:734-529-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076560207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN53240034Medicare PIN
MIMI3336003Medicare PIN