Provider Demographics
NPI:1285154955
Name:CHAIN, KRISTA GUDRAIS (MD)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:GUDRAIS
Last Name:CHAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 CATHERINE STREET
Mailing Address - Street 2:5231E MED SCI I
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-5602
Mailing Address - Country:US
Mailing Address - Phone:734-764-3270
Mailing Address - Fax:734-615-2964
Practice Address - Street 1:1301 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-2026
Practice Address - Country:US
Practice Address - Phone:734-764-3270
Practice Address - Fax:734-615-2964
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301113208390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program