Healthcare Provider Details

I. General information

NPI: 1053503748
Provider Name (Legal Business Name): KRISTINA N KARANEC DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CHERRY ST SE
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

245 STATE ST SE STE 228
GRAND RAPIDS MI
49503
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-5050
  • Fax: 616-685-8962
Mailing address:
  • Phone: 616-685-1808
  • Fax: 616-685-1850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number5315048769
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: