Healthcare Provider Details

I. General information

NPI: 1073962296
Provider Name (Legal Business Name): CHRISTOPHER JOHN BILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25311 LITTLE MACK AVE STE B
SAINT CLAIR SHORES MI
48081-3301
US

IV. Provider business mailing address

519 SUNNINGDALE DR
GROSSE POINTE WOODS MI
48236-1667
US

V. Phone/Fax

Practice location:
  • Phone: 586-498-2400
  • Fax:
Mailing address:
  • Phone: 313-881-4199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number4301504323
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberB400115429237
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: