Individual
KRISTINA RAE VANDER MARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1324 LAKELAND HILLS BLVD, LAKELAND, FL 33805-4543
(863) 284-6860
Mailing address
22255 GREENFIELD RD STE 352, SOUTHFIELD, MI 48075-3712
(248) 849-3401
(248) 849-4106
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
4301076692
MI
207V00000X
Obstetrics & Gynecology Physician
Primary
ME170074
FL
207VG0400X
Gynecology Physician
4301076692
MI
207VX0000X
Obstetrics Physician
4301076692
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4789630
—
MI
Enumeration date
10/04/2006
Last updated
02/18/2025
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