Healthcare Provider Details

I. General information

NPI: 1881232635
Provider Name (Legal Business Name): CHRISTOPHER CUMMINGS PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 RIVER OAKS DR
MILFORD MI
48381-1037
US

IV. Provider business mailing address

202 GENESEE POINT ST
HENDERSON NV
89074-8737
US

V. Phone/Fax

Practice location:
  • Phone: 248-717-0074
  • Fax: 248-717-0150
Mailing address:
  • Phone: 801-473-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2241
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: