Provider Demographics
NPI:1255383709
Name:MICHAEL, KRISTI C (MD)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:C
Last Name:MICHAEL
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 1:8001 YOUREE DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2302
Mailing Address - Country:US
Mailing Address - Phone:318-212-3890
Mailing Address - Fax:318-212-3888
Practice Address - Street 1:8001 YOUREE DR
Practice Address - Street 2:SUITE 600
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2302
Practice Address - Country:US
Practice Address - Phone:318-212-3890
Practice Address - Fax:318-212-3888
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA14447R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1121436Medicaid
LA4E374Medicare PIN
LA4E374CV71Medicare PIN
LA1121436Medicaid