Healthcare Provider Details

I. General information

NPI: 1780667246
Provider Name (Legal Business Name): CHRISTIAN E MACHADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22250 PROVIDENCE DR STE #705
SOUTHFIELD MI
48075-4825
US

IV. Provider business mailing address

22250 PROVIDENCE DR STE #705
SOUTHFIELD MI
48075-4825
US

V. Phone/Fax

Practice location:
  • Phone: 248-552-9858
  • Fax: 248-559-6783
Mailing address:
  • Phone: 248-552-9858
  • Fax: 248-559-6783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301407565
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number4301407565
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: