MEDICARE: CSD MEDICAL CENTER, CORP

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1104794361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CSD MEDICAL CENTER, CORP

Provider Business Mailing Address
First Line	:	3712 W 12TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4126
Country	:	US
Telephone Number	:	954-376-2384
Fax Number	:

Provider Business Practice Location Address
First Line	:	3712 W 12TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4126
Country	:	US
Telephone Number	:	954-376-2384
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEVEN D CHRISTESEN
Credential	:	MD
Telephone Number	:	954-376-2384

Provider Enumeration Date	:	10/28/2025
Last Update Date	:	10/28/2025

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