MEDICARE: DR. CHAD KENT CHRISTIANSEN 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	390200000X	Student in an Organized Health Care Education/Training Program	390200000X	UT

General Provider Information

NPI Number	:	1245485499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD KENT CHRISTIANSEN M.D.

Provider Business Mailing Address
First Line	:	2648 HARTFORD ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3610
Country	:	US
Telephone Number	:	801-712-7328
Fax Number	:

Provider Business Practice Location Address
First Line	:	5169 COTTONWOOD ST STE 303
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-6768
Country	:	US
Telephone Number	:	801-507-6900
Fax Number	:

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

Provider Enumeration Date	:	12/01/2008
Last Update Date	:	12/01/2008

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