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MICHIANA NEUROLOGIC MEDICINE, PC
NPI 1336414499
Psychiatry & Neurology - Neurology in Granger, IN

Active since March 21, 2012CLIA 15D2348097 · Certificate of Compliance
14404 STATE ROAD 23 STE B, GRANGER, IN 46530(574) 252-7795(574) 252-7796 Get Directions Write a Review

NPPES record last updated: July 31, 2026. Verified against the NPPES registry weekly; last sync: September 27, 2026.

About Michiana Neurologic Medicine, Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MICHIANA NEUROLOGIC MEDICINE, PC (NPI 1336414499) is a healthcare organization registered as a neurology in Granger, Indiana and active in the NPI registry since March 2012. The organization holds a CLIA Certificate of Compliance certificate valid through July 29, 2028, maintains a secondary practice location in Mishawaka, and lists Kevin R Kristl, M.d., as its authorized official.

NPPES Registry Identity

NPI1336414499
Entity TypeOrganization
Primary Taxonomy2084N0400X
Legal Business NameMICHIANA NEUROLOGIC MEDICINE, PC
Location Address14404 STATE ROAD 23 STE BGranger, IN 46530-7778
Mailing Address1710 E Day RdMishawaka, IN 46545-4300 · (574) 252-7795 · Fax (574) 252-7796
Phone(574) 252-7795
Fax(574) 252-7796
Organization SubpartNo
Authorized OfficialKevin R KristlM.d. · (574) 252-7795
Enumeration DateMarch 21, 2012
Last NPPES UpdateJuly 31, 2026
NPPES CertifiedJuly 31, 2026
✔ NPI 1336414499 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · NeurologyAllopathic & Osteopathic Physicians
Taxonomy Code2084N0400X
License✔ Licensed in IN · 01037448A
Definition
A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.
14404 STATE ROAD 23 STE B, Granger, IN 46530
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Secondary Practice Location 1

Location 11710 E Day RdMishawaka, IN 46545-4300 · Phone (574) 252-7795 · Fax (574) 252-7796

Other Identifiers 1

Medicaid100179640IN

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 15D2348097

Michiana Neurologic Medicine PC · Granger, IN
Active · expires Jul 29, 2028
CLIA Number15D2348097
Laboratory TypePhysician Office
Certificate Effective DateJuly 30, 2026
Certificate Expiration DateJuly 29, 2028
Laboratory DirectorKevin R. Kristl
Laboratory Phone(574) 252-7795
Laboratory LocationMichiana Neurologic Medicine PC14404 St Rd 23, Granger, IN 46530
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KEVIN R KRISTL M.D.
Psychiatry & Neurology (Neurology)
14404 STATE ROAD 23 STE B
GRANGER, IN 46530
St. Joseph County (574) 252-7795

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Michiana Neurologic Medicine, PC's NPI number?

The NPI number for Michiana Neurologic Medicine, PC is 1336414499. It was assigned to this organization in the NPPES registry on March 21, 2012.

Where is Michiana Neurologic Medicine, PC located?

Michiana Neurologic Medicine, PC is located at 14404 State Road 23 Ste B, Granger, IN 46530. The listed phone number is (574) 252-7795.

What is Michiana Neurologic Medicine, PC's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Neurology, with taxonomy code 2084N0400X.

Does Michiana Neurologic Medicine, PC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 15D2348097) is associated with this NPI, valid through July 29, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Michiana Neurologic Medicine, PC was last updated on July 31, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 60 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.