MEDICARE: MR. MICHAEL JOSEPH KRISTOVIC L.C.S.W.

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	1041C0700X	Clinical Social Worker	149.013791	IL
2	1041C0700X	Clinical Social Worker	6801099286	MI

General Provider Information

NPI Number	:	1518254614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL JOSEPH KRISTOVIC L.C.S.W.

Provider Business Mailing Address
First Line	:	2652 SPRING ARBOR RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3604
Country	:	US
Telephone Number	:	312-610-9552
Fax Number	:

Provider Business Practice Location Address
First Line	:	2652 SPRING ARBOR RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3604
Country	:	US
Telephone Number	:	312-610-9552
Fax Number	:

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

Provider Enumeration Date	:	07/09/2011
Last Update Date	:	03/26/2025

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