MEDICARE: KRISTEN NICOLE CARRILLO-KAPPUS MD, MPH

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	207V00000X	Obstetrics & Gynecology Physician	4301511977	MI

General Provider Information

NPI Number	:	1639707896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN NICOLE CARRILLO-KAPPUS MD, MPH

Provider Business Mailing Address
First Line	:	2790 HEALTH PKWY
Second Line	:
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-6934
Country	:	US
Telephone Number	:	989-779-5642
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 SOUTH DR STE 220
Second Line	:
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-3255
Country	:	US
Telephone Number	:	989-773-3411
Fax Number	:	989-546-8557

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

Provider Enumeration Date	:	03/31/2020
Last Update Date	:	08/26/2024

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