Healthcare Provider Details

I. General information

NPI: 1023975752
Provider Name (Legal Business Name): KRISTOPHER PAUL BOTTINI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KRIS BOTTINI R.N.

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29570 ARMADA RIDGE RD
RICHMOND MI
48062-4521
US

IV. Provider business mailing address

29570 ARMADA RIDGE RD
RICHMOND MI
48062-4521
US

V. Phone/Fax

Practice location:
  • Phone: 586-612-2379
  • Fax:
Mailing address:
  • Phone: 586-612-2379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704343525
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704343525
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: