Healthcare Provider Details

I. General information

NPI: 1164405635
Provider Name (Legal Business Name): CHRISTOPHER J MEHALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 W COLLEGE AVE
MARQUETTE MI
49855-2705
US

IV. Provider business mailing address

2837 US 41 WEST
MARQUETTE MI
49855-2675
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-7808
  • Fax:
Mailing address:
  • Phone: 906-225-3964
  • Fax: 906-226-3875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number4301052676
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: