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General NPI Number Information
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NPI Number | 1477784056
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Entity Type | Individual
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Provider Name | CHRISTINA BAKALIS
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Gender | Female
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Dates
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Enumeration Date | 07/31/2009
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Last Update Date | 10/03/2018
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Provider Practice Location Address
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Address Line | 5900 BYRON CENTER AVE SW
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City | WYOMING
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State | MI
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Zip | 49519
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Country | US
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Telephone | 616-252-7837
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Fax | 616-252-6939
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Provider Business Mailing Address
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Address Line | 5900 BYRON CENTER AVE SW MEDICAL ADMINISTRATION
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City | WYOMING
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State | MI
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Zip | 49519-9606
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Country | US
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Telephone | 616-252-7837
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Fax | 616-252-6939
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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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 4301095360
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301095360
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | Q6145
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 4301095360
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License Number State | MI
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