MEDICARE: CARL WOODROW CHRISTENSEN MD

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	207VG0400X	Gynecology Physician	4301048048	MI
2	207QA0401X	Addiction Medicine (Family Medicine) Physician	4301048048	MI

General Provider Information

NPI Number	:	1598703621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL WOODROW CHRISTENSEN MD

Provider Business Mailing Address
First Line	:	4870 W CLARK RD STE 201
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48197-1104
Country	:	US
Telephone Number	:	734-434-6600
Fax Number	:	313-447-2244

Provider Business Practice Location Address
First Line	:	4870 W CLARK RD STE 201
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48197-1104
Country	:	US
Telephone Number	:	734-434-6600
Fax Number	:	313-447-2244

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	11/07/2012

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