MEDICARE: DR. CHRISTOPHER JOHN REMISHOFSKY 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	207N00000X	Dermatology Physician	4301084290	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P47710003	OTHER	MI	MEDICARE PTAN

General Provider Information

NPI Number	:	1649487984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER JOHN REMISHOFSKY MD

Provider Business Mailing Address
First Line	:	39242 DEQUINDRE RD
Second Line	:	SUITE 105
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-1764
Country	:	US
Telephone Number	:	586-979-1750
Fax Number	:

Provider Business Practice Location Address
First Line	:	39242 DEQUINDRE RD
Second Line	:	SUITE 105
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-1764
Country	:	US
Telephone Number	:	586-979-1750
Fax Number	:

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	09/26/2022

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