Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 5101018602 | MI |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 5101018602 | MI |
NPI | 1235441528 |
---|---|
Provider Name | Dr. Kristy Anne Beckholt |
First Address | Lansing, MI 48912 |
Second Address | Lansing, MI 48912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2010 |
Last Update Date | 07/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1235441528 | (05) | MI |
5330585 | BCBS PIN (01) | MI |