Provider Demographics
NPI:1194136721
Name:KREZOSKI-EVANS, KATHRYN F (DO)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:F
Last Name:KREZOSKI-EVANS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9975 W OTTAWA AVE
Mailing Address - Street 2:
Mailing Address - City:EMPIRE
Mailing Address - State:MI
Mailing Address - Zip Code:49630-9618
Mailing Address - Country:US
Mailing Address - Phone:231-835-2088
Mailing Address - Fax:231-935-2534
Practice Address - Street 1:9975 W OTTAWA AVE
Practice Address - Street 2:
Practice Address - City:EMPIRE
Practice Address - State:MI
Practice Address - Zip Code:49630-9618
Practice Address - Country:US
Practice Address - Phone:231-835-2088
Practice Address - Fax:231-835-2534
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine