Healthcare Provider Details

I. General information

NPI: 1952470361
Provider Name (Legal Business Name): CHRISTINA MARIE KOONCE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 N HIGH ST
LANSING MI
48906-4597
US

IV. Provider business mailing address

1717 N HIGH ST
LANSING MI
48906-4597
US

V. Phone/Fax

Practice location:
  • Phone: 517-253-8243
  • Fax: 517-371-4245
Mailing address:
  • Phone: 517-253-8243
  • Fax: 517-371-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00004301093690
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: