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General NPI Number Information
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NPI Number | 1215165071
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Entity Type | Individual
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Provider Name | KRISTINA M MANION D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 4055 CASCADE RD SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2149
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Country | US
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Telephone | 616-252-5760
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 BYRON CENTER AVE SW
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City | WYOMING
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State | MI
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Zip | 49519-9606
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Country | US
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Telephone | 616-252-5760
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | 5101018124
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License Number State | MI
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