Healthcare Provider Details

I. General information

NPI: 1033855382
Provider Name (Legal Business Name): CHRISTOPHER SIDWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 08/06/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 FULLER RD
ANN ARBOR MI
48105-2303
US

IV. Provider business mailing address

1500 EAST MEDICAL CENTER DRIVE ROOM NUMBER 2381 CVC
ANN ARBOR MI
48109
US

V. Phone/Fax

Practice location:
  • Phone: 734-998-2020
  • Fax:
Mailing address:
  • Phone: 734-936-8214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351048954
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4351048954
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: