Provider Demographics
NPI:1477380244
Name:KRIGBAUM, MICHAEL (CST)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KRIGBAUM
Suffix:
Gender:M
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 E KESWICK DAM RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-1209
Mailing Address - Country:US
Mailing Address - Phone:530-921-5715
Mailing Address - Fax:
Practice Address - Street 1:3720 E KESWICK DAM RD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-1209
Practice Address - Country:US
Practice Address - Phone:530-921-5715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist