Healthcare Provider Details

I. General information

NPI: 1164830048
Provider Name (Legal Business Name): CARL CHRISTENSEN MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2370 LEFORGE RD
YPSILANTI MI
48198-9638
US

IV. Provider business mailing address

2370 LEFORGE RD
YPSILANTI MI
48198-9638
US

V. Phone/Fax

Practice location:
  • Phone: 734-448-0226
  • Fax: 313-447-2244
Mailing address:
  • Phone: 734-448-0226
  • Fax: 313-447-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number4301048048
License Number StateMI

VIII. Authorized Official

Name: DR. CARL WOODROW CHRISTENSEN
Title or Position: SOLE MEMBER
Credential: MD
Phone: 734-218-5317