Healthcare Provider Details

I. General information

NPI: 1225784531
Provider Name (Legal Business Name): KRISTEN MIKHAIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2508
US

IV. Provider business mailing address

1904 VALLEYVIEW DR
ANN ARBOR MI
48105-9362
US

V. Phone/Fax

Practice location:
  • Phone: 616-233-1678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.155338
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: