Healthcare Provider Details

I. General information

NPI: 1972893824
Provider Name (Legal Business Name): KATHERINE BARBARA KRIVE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 W SHIAWASSEE ST
LANSING MI
48915-1271
US

IV. Provider business mailing address

1612 W SHIAWASSEE ST
LANSING MI
48915-1271
US

V. Phone/Fax

Practice location:
  • Phone: 517-803-3314
  • Fax: 612-500-4648
Mailing address:
  • Phone: 517-803-3314
  • Fax: 612-500-4648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number5101019421
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: