Healthcare Provider Details

I. General information

NPI: 1245485499
Provider Name (Legal Business Name): CHAD KENT CHRISTIANSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5169 COTTONWOOD ST STE 303
MURRAY UT
84107-6768
US

IV. Provider business mailing address

2648 HARTFORD ST
SALT LAKE CITY UT
84106-3610
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-6900
  • Fax:
Mailing address:
  • Phone: 801-712-7328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number390200000X
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: