Healthcare Provider Details

I. General information

NPI: 1710959127
Provider Name (Legal Business Name): KRISTI J LEDBETTER DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTI SHRANK

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2797 SPRING ARBOR RD STE. A
JACKSON MI
49203-3605
US

IV. Provider business mailing address

2797 SPRING ARBOR RD STE. A
JACKSON MI
49203-3605
US

V. Phone/Fax

Practice location:
  • Phone: 517-784-0900
  • Fax: 517-784-7835
Mailing address:
  • Phone: 517-784-0900
  • Fax: 517-784-7835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberKL002092
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: