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NPI Code Detail

MEDICARE: DR. WAYNE A CHRISTENSON D.O.

MEDICARE: DR. WAYNE A CHRISTENSON D.O.
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
1207Q00000XFamily Medicine Physician5101014162MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407966773
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WAYNE A CHRISTENSON D.O.
Provider Business Mailing Address
First Line : 5900 BYRON CENTER AVE SW
Second Line : MEDICAL ADMINISTRATION
City : WYOMING
State : MI
Zip : 49519-9606
Country : US
Telephone Number : 616-252-3243
Fax Number : 616-252-0260
Provider Business Practice Location Address
First Line : 2550 W MAIN ST
Second Line :
City : LOWELL
State : MI
Zip : 49331-8695
Country : US
Telephone Number : 616-252-5600
Fax Number : 616-252-5660
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 12/04/2017

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