MEDICARE: CARL CHRISTENSEN MD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0401X	Addiction Medicine (Family Medicine) Physician	4301048048	MI

General Provider Information

NPI Number	:	1164830048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARL CHRISTENSEN MD PLLC

Provider Business Mailing Address
First Line	:	2370 LEFORGE RD
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48198-9638
Country	:	US
Telephone Number	:	734-448-0226
Fax Number	:	313-447-2244

Provider Business Practice Location Address
First Line	:	2370 LEFORGE RD
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48198-9638
Country	:	US
Telephone Number	:	734-448-0226
Fax Number	:	313-447-2244

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	DR. CARL WOODROW CHRISTENSEN
Credential	:	MD
Telephone Number	:	734-218-5317

Provider Enumeration Date	:	07/23/2014
Last Update Date	:	07/23/2014

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