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General NPI Number Information
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NPI Number | 1922022409
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Entity Type | Individual
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Provider Name | CHRISTOPHER CLARK MASSIN DO
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 200 JEFFERSON AVE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503
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Country | US
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Telephone | 616-685-6200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5329
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City | SAGINAW
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State | MI
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Zip | 48603-0329
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Country | US
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Telephone | 616-364-6700
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Fax | 989-401-4245
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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 | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 5101012108
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 5101012108
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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 | 5101012108
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License Number State | MI
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