Healthcare Provider Details

I. General information

NPI: 1093885204
Provider Name (Legal Business Name): CHRISTOPHER P CZATA P.A.-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 09/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27560 HOOVER
WARREN MI
48093-3400
US

IV. Provider business mailing address

18001 E 10 MILE RD
ROSEVILLE MI
48066-3803
US

V. Phone/Fax

Practice location:
  • Phone: 586-757-6400
  • Fax: 586-757-8400
Mailing address:
  • Phone: 586-247-4300
  • Fax: 313-300-5826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601004363
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: