Healthcare Provider Details

I. General information

NPI: 1629768940
Provider Name (Legal Business Name): CHRISTIAN GABRIEL DONDONAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HARRINGTON ST
MOUNT CLEMENS MI
48043-2920
US

IV. Provider business mailing address

1000 HARRINGTON ST
MOUNT CLEMENS MI
48043-2920
US

V. Phone/Fax

Practice location:
  • Phone: 586-493-3727
  • Fax:
Mailing address:
  • Phone: 586-493-3727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2026035159
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5151016086
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: