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NPI Code Detail

MEDICARE: MICHAEL KRSTEVSKI

MEDICARE: MICHAEL KRSTEVSKI
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
1103T00000XPsychologist6301015132MI

General Provider Information

NPI Number : 1821352543
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL KRSTEVSKI
Provider Business Mailing Address
First Line : 42245 ANN ARBOR RD E
Second Line : 101
City : PLYMOUTH
State : MI
Zip : 48170-4311
Country : US
Telephone Number : 313-727-9202
Fax Number :
Provider Business Practice Location Address
First Line : 2075 WEST BIG BEAVER
Second Line : 520
City : TROY
State : MI
Zip : 48084-3442
Country : US
Telephone Number : 248-646-6659
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2012
Last Update Date : 04/05/2013

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