MEDICARE: KRISTINE MARIE RIBITCH P.A.-C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601005381	MI

General Provider Information

NPI Number	:	1356591135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE MARIE RIBITCH P.A.-C.

Provider Business Mailing Address
First Line	:	2853 HEALTH PARKWAY
Second Line	:	SUITE B
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858
Country	:	US
Telephone Number	:	989-775-7641
Fax Number	:	989-775-6472

Provider Business Practice Location Address
First Line	:	2853 HEALTH PARKWAY
Second Line	:	SUITE B
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-3872
Country	:	US
Telephone Number	:	989-775-7641
Fax Number	:	989-775-6472

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2008
Last Update Date	:	02/07/2014

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