Provider Demographics
NPI:1447513635
Name:GAUNT, KRISTINA ANN (MD)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANN
Last Name:GAUNT
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 1:1316 MERCY DR STE 140
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1891
Mailing Address - Country:US
Mailing Address - Phone:231-739-9461
Mailing Address - Fax:231-739-1984
Practice Address - Street 1:1316 MERCY DR
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1891
Practice Address - Country:US
Practice Address - Phone:231-739-9461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301111753208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty