Healthcare Provider Details

I. General information

NPI: 1639707896
Provider Name (Legal Business Name): KRISTEN NICOLE CARRILLO-KAPPUS MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SOUTH DR STE 220
MOUNT PLEASANT MI
48858-3255
US

IV. Provider business mailing address

2790 HEALTH PKWY
MOUNT PLEASANT MI
48858-6934
US

V. Phone/Fax

Practice location:
  • Phone: 989-773-3411
  • Fax: 989-546-8557
Mailing address:
  • Phone: 989-779-5642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301511977
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: