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General NPI Number Information
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NPI Number | 1922067461
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Entity Type | Individual
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Provider Name | KRISTINA L HYDE MD
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Gender | Female
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 1949 W 12 MILE RD STE 100
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City | BERKLEY
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State | MI
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Zip | 48072-1868
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Country | US
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Telephone | 248-551-0615
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Fax | 248-551-1245
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Provider Business Mailing Address
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Address Line | 26901 BEAUMONT BLVD STE 3D400FSC
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3849
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Country | US
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Telephone |
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Fax | 248-552-0307
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 4301050403
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License Number State | MI
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