Individual
TARA ELIZABETH KRISTOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
71 E LONG LAKE RD, BLOOMFIELD HILLS, MI 48304-9996
(248) 533-0000
(248) 385-5541
Mailing address
71 E LONG LAKE RD, BLOOMFIELD HILLS, MI 48304-9996
(248) 533-0000
(248) 385-5541
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4704300214
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704300214
DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS BOARD OF NURSING
MI
Enumeration date
06/01/2018
Last updated
06/01/2018
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