Healthcare Provider Details

I. General information

NPI: 1073595674
Provider Name (Legal Business Name): CHRISTINE AMBER ELSHOLZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6297 DIXIE HIGHWAY
BRIDGEPORT MI
48722-9635
US

IV. Provider business mailing address

501 LAPEER AVE
SAGINAW MI
48607-1208
US

V. Phone/Fax

Practice location:
  • Phone: 989-759-6460
  • Fax: 989-759-6465
Mailing address:
  • Phone: 989-759-6464
  • Fax: 989-399-8233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301063548
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: