Provider Demographics
NPI:1992778807
Name:MASCHKE, KRISTIN S (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:S
Last Name:MASCHKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:829 N CENTER AVE
Mailing Address - Street 2:SUITE 298
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1595
Mailing Address - Country:US
Mailing Address - Phone:989-731-7708
Mailing Address - Fax:989-731-7929
Practice Address - Street 1:3040 BOURN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:MI
Practice Address - Zip Code:49756-8134
Practice Address - Country:US
Practice Address - Phone:989-786-4877
Practice Address - Fax:989-786-2187
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068537208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4503518Medicaid
MI0F96004OtherGROUP MEDICARE ID NUMBER
MI4503518Medicaid
MI0N71530Medicare ID - Type Unspecified