Kristina Ivan, MS, CGC

Primary specialty

Genetic Counselor (M.S.)Taxonomy code 170300000X

Practice address

3577 W 13 Mile Rd Ste 140
Royal Oak, MI 48073-6710

Phone

(248) 551-5792

Fax

(248) 551-8437

NPI assigned

Sep 17, 2021

Last updated

Sep 17, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kristina Hermann Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1639849995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22006 E 13 MILE RD",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480821482",
            "telephone_number": "586-917-8015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3577 W 13 MILE RD STE 140",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736710",
            "telephone_number": "248-551-5792",
            "fax_number": "248-551-8437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVAN",
        "first_name": "KRISTINA",
        "credential": "MS, CGC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-17",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "170300000X",
            "taxonomy_group": "",
            "desc": "Genetic Counselor, MS",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTINA",
            "last_name": "HERMANN",
            "credential": "MS, CGC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Kristin Mary Isherwood, OTR/L
• Ciara Jordan Ivanics, MD
• Felicia Ivascu
• Ivyhealth Network LLC Dba Ivy Health Network
• Rajesh V Iyer, MD
• Abdelrahman Izraiqi, M.D.

• Genetic Counselor (M.S.) in Royal Oak, MI
• Providers in Royal Oak, MI by specialty
• Genetic Counselor (M.S.) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.