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General NPI Number Information
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NPI Number | 1104451087
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Entity Type | Individual
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Provider Name | CHRISTOPHER JUSTIN GIDEON MD
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Gender | Male
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Dates
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Enumeration Date | 03/11/2020
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 209 E WASHINGTON AVE STE 395
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City | JACKSON
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State | MI
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Zip | 49201-2475
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Country | US
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Telephone | 808-480-5420
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Fax |
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Provider Business Mailing Address
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Address Line | 1164 BISHOP ST STE 940 #627
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City | HONOLULU
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State | HI
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Zip | 96813-2810
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD-25655-0
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4351048355
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License Number State | MI
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