Provider Demographics
NPI:1104929413
Name:KRINGS, MICHELLE (PT,ATC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:KRINGS
Suffix:
Gender:F
Credentials:PT,ATC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:SIMOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, ATC
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:37699 6 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3994
Practice Address - Country:US
Practice Address - Phone:734-953-4155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN63580007OtherMEDICARE
MIP01399584Medicare PIN
MIN63580007OtherMEDICARE