Healthcare Provider Details

I. General information

NPI: 1386103661
Provider Name (Legal Business Name): MICHAEL THAYER CHRISTENSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2019
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 S VAL VISTA DR # C104
GILBERT AZ
85297-7318
US

IV. Provider business mailing address

3530 S VAL VISTA DR # C104
GILBERT AZ
85297-7318
US

V. Phone/Fax

Practice location:
  • Phone: 480-791-1400
  • Fax: 480-791-1409
Mailing address:
  • Phone: 480-791-1400
  • Fax: 480-791-1409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number25678
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number76667
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: