Healthcare Provider Details

I. General information

NPI: 1720249667
Provider Name (Legal Business Name): KRISTINA LYNN STURGILL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HINCKLEY BLVD
JACKSON MI
49203-6152
US

IV. Provider business mailing address

PO BOX 67000 DEPT 272801
DETROIT MI
48267-2728
US

V. Phone/Fax

Practice location:
  • Phone: 517-784-0588
  • Fax: 517-787-3462
Mailing address:
  • Phone: 517-917-8005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101017727
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: