Basic Information
Provider Information
NPI: 1861847253
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GETZ
FirstName: KRISTA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
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Mailing Information
Address1: 2333 BIDDLE AVENUE
Address2: HENRY FORD WYANDOTTE HOSPITAL
City: WYANDOTTE
State: MI
PostalCode: 48129
CountryCode: US
TelephoneNumber: 7342879029
FaxNumber:  
Practice Location
Address1: 2333 BIDDLE AVE
Address2: HENRY FORD WYANDOTTE HOSPITAL
City: WYANDOTTE
State: MI
PostalCode: 481924668
CountryCode: US
TelephoneNumber: 7342879029
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/04/2016
LastUpdateDate: 10/21/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
213E00000X5901002648MIY Podiatric Medicine & Surgery Service ProvidersPodiatrist 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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