Provider Demographics
NPI:1043887672
Name:KOSTOFF, KRISTI (WHNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:KOSTOFF
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 BREST RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:MI
Mailing Address - Zip Code:48166-9040
Mailing Address - Country:US
Mailing Address - Phone:734-735-2747
Mailing Address - Fax:
Practice Address - Street 1:1046 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3113
Practice Address - Country:US
Practice Address - Phone:734-457-9034
Practice Address - Fax:734-457-4030
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704212854207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty