MEDICARE: DR. CHRISTINE T WADE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	4301072668	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083723647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINE T WADE M.D.

Provider Business Mailing Address
First Line	:	742 ARUSHA DR
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48341-1075
Country	:	US
Telephone Number	:	248-332-0154
Fax Number	:

Provider Business Practice Location Address
First Line	:	1109 W LONG LAKE RD
Second Line	:	SUITE 102
City	:	BLOOMFIELD TOWNSHIP
State	:	MI
Zip	:	48302-1967
Country	:	US
Telephone Number	:	248-594-0002
Fax Number	:	248-594-6236

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	06/14/2024

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