Healthcare Provider Details

I. General information

NPI: 1285367441
Provider Name (Legal Business Name): MICHAEL DEAN CHRISTENSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 E 1ST ST
DULUTH MN
55805-2107
US

IV. Provider business mailing address

3067 S MILWAUKEE AVE
OLIVER WI
54880-8163
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-4555
  • Fax:
Mailing address:
  • Phone: 715-566-2640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15512
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: