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NPI Code Detail

MEDICARE: CHRISTINA MARIE KOONCE M.D.

MEDICARE: CHRISTINA MARIE KOONCE M.D.
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
1207Q00000XFamily Medicine Physician00004301093690MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952470361
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINA MARIE KOONCE M.D.
Provider Business Mailing Address
First Line : 1717 N HIGH ST
Second Line :
City : LANSING
State : MI
Zip : 48906-4597
Country : US
Telephone Number : 517-253-8243
Fax Number : 517-371-4245
Provider Business Practice Location Address
First Line : 1717 N HIGH ST
Second Line :
City : LANSING
State : MI
Zip : 48906-4597
Country : US
Telephone Number : 517-253-8243
Fax Number : 517-371-4245
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2006
Last Update Date : 05/31/2023

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