Provider Demographics
NPI:1497733190
Name:SPENCE, KRISTINE KNOP (DO)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:KNOP
Last Name:SPENCE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4323
Mailing Address - Country:US
Mailing Address - Phone:989-753-8453
Mailing Address - Fax:989-755-9983
Practice Address - Street 1:926 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4323
Practice Address - Country:US
Practice Address - Phone:989-753-8453
Practice Address - Fax:989-755-9983
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013032207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P114557OtherBLUE CARE NETWORK ID#
MI113388500Medicaid
MIOG36041Medicare ID - Type Unspecified
H63332Medicare UPIN