Healthcare Provider Details

I. General information

NPI: 1043887672
Provider Name (Legal Business Name): KRISTI KOSTOFF WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1046 N MONROE ST
MONROE MI
48162-3113
US

IV. Provider business mailing address

4245 BREST RD
NEWPORT MI
48166-9040
US

V. Phone/Fax

Practice location:
  • Phone: 734-457-9034
  • Fax: 734-457-4030
Mailing address:
  • Phone: 734-735-2747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4704212854
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: