Provider Demographics
NPI:1992048284
Name:MAUCH, KRISTALYN J (MD)
Entity type:Individual
Prefix:
First Name:KRISTALYN
Middle Name:J
Last Name:MAUCH
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 1:401 LONG RAPIDS PLZ
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1394
Mailing Address - Country:US
Mailing Address - Phone:989-356-9333
Mailing Address - Fax:989-356-0804
Practice Address - Street 1:401 LONG RAPIDS PLZ
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707
Practice Address - Country:US
Practice Address - Phone:989-356-9333
Practice Address - Fax:989-356-0804
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFD2397304-8208207X00000X
TXR6241207X00000X
390200000X
MI4301119297207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty