| Doctor Name: | KRISTIN PUTNAM |
| NPI Number: | 1033599121 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 5101021904 |
| Business Practice Address: | 1215 E Michigan Ave Attn: Carol Hine, Program Coordinator Lansing, MI - 489121811 |
| Business Phone Number: | 5173642766 |
| Business Fax Number: | 5173643002 |
| Mailing Address: | 1215 E Michigan Ave, Attn: Carol Hine, Program Coordinator LANSING |
| State: | MI |
| Postal Code: | 489121811 |
| Phone Number: | 6172919818 |
| Fax Number: | 5173643002 |
| NPI Enumeration Date: | 06/03/2015 |
| NPI Last Update Date: | 06/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 5101021904 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |