MEDICARE: DR. CHRISTOPHER CLARENCE THESSEN 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	207L00000X	Anesthesiology Physician	ME81504	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1649215278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER CLARENCE THESSEN MD

Provider Business Mailing Address
First Line	:	249 LANSING ISLAND DR
Second Line	:
City	:	INDIAN HARBOUR BEACH
State	:	FL
Zip	:	32937-5102
Country	:	US
Telephone Number	:	321-242-9599
Fax Number	:	321-242-9599

Provider Business Practice Location Address
First Line	:	249 LANSING ISLAND DR
Second Line	:
City	:	INDIAN HARBOUR BEACH
State	:	FL
Zip	:	32937-5102
Country	:	US
Telephone Number	:	321-242-9599
Fax Number	:	321-242-9599

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

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	10/21/2013

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