Healthcare Provider Details

I. General information

NPI: 1992778807
Provider Name (Legal Business Name): KRISTIN S MASCHKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 BOURN ST
LEWISTON MI
49756-8134
US

IV. Provider business mailing address

829 N CENTER AVE SUITE 298
GAYLORD MI
49735-1595
US

V. Phone/Fax

Practice location:
  • Phone: 989-786-4877
  • Fax: 989-786-2187
Mailing address:
  • Phone: 989-731-7708
  • Fax: 989-731-7929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301068537
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: