Healthcare Provider Details

I. General information

NPI: 1700382827
Provider Name (Legal Business Name): KRISTI Y WU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W UNIVERSITY DR
ROCHESTER HILLS MI
48307-1863
US

IV. Provider business mailing address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

V. Phone/Fax

Practice location:
  • Phone: 248-601-4900
  • Fax:
Mailing address:
  • Phone: 507-284-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number66019
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: