Healthcare Provider Details

I. General information

NPI: 1245559798
Provider Name (Legal Business Name): CHRISTOPHER PAUL CONTARDO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NILES RD STE 5
SAINT JOSEPH MI
49085-3225
US

IV. Provider business mailing address

2500 NILES RD STE 5
SAINT JOSEPH MI
49085-3225
US

V. Phone/Fax

Practice location:
  • Phone: 692-810-4082
  • Fax: 269-281-0465
Mailing address:
  • Phone: 692-810-4082
  • Fax: 269-281-0465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6301015377
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301015377
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: