| Michiana Neurologic Medicine, Pc | |
|
229 Red Coach Dr Ste 105 Mishawaka IN 46545-3195 | |
| (574) 252-7795 | |
| (574) 252-7796 |
| Full Name | Michiana Neurologic Medicine, Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 229 Red Coach Dr Ste 105, Mishawaka, Indiana |
| Authorized Official Name and Position | Kevin Robert Kristl (PRESIDENT) |
| Authorized Official Contact | 5742527795 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michiana Neurologic Medicine, Pc 229 Red Coach Dr Ste 105 Mishawaka IN 46545-3195 Ph: (574) 252-7795 | Michiana Neurologic Medicine, Pc 229 Red Coach Dr Ste 105 Mishawaka IN 46545-3195 Ph: (574) 252-7795 |
| NPI Number | 1336414499 |
|---|---|
| Provider Enumeration Date | 03/21/2012 |
| Last Update Date | 03/21/2012 |
| Medicare PECOS PAC ID | 3274795646 |
|---|---|
| Medicare Enrollment ID | O20120501000241 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336414499 | NPI | - | NPPES |
| 100179640 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 01037448A (Indiana) | Primary |
| Provider Name | Kevin R Kristl |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1811941768 PECOS PAC ID: 6204930787 Enrollment ID: I20070323000210 |
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