Organization
MICHIANA NEUROLOGIC MEDICINE, PC
Active
Organization
MICHIANA NEUROLOGIC MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN R KRISTL (M.D.)
(574) 252-7795
Entity
Organization
Contact information
Practice address
14404 STATE ROAD 23 STE B, GRANGER, IN 46530-7778
(574) 252-7795
(574) 252-7796
Mailing address
1710 E DAY RD, MISHAWAKA, IN 46545-4300
(574) 252-7795
(574) 252-7796
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01037448A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100179640
—
IN
Enumeration date
03/21/2012
Last updated
07/31/2026
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