Provider Demographics
NPI:1972893824
Name:KRIVE, KATHERINE BARBARA (DO)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:BARBARA
Last Name:KRIVE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 W SHIAWASSEE ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48915-1271
Mailing Address - Country:US
Mailing Address - Phone:517-803-3314
Mailing Address - Fax:612-500-4648
Practice Address - Street 1:1612 W SHIAWASSEE ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915-1271
Practice Address - Country:US
Practice Address - Phone:517-803-3314
Practice Address - Fax:612-500-4648
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010194212084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1972893824Medicaid