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NPI Code Detail

MEDICARE: WAYNE A CHRISTENSON JR. M.D.

MEDICARE: WAYNE A CHRISTENSON JR. M.D.
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
12084P0800XPsychiatry Physician01039706AIN
22084P0804XChild & Adolescent Psychiatry Physician01039706AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000203802OTHERINANTHEM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750324711
Entity Type Code : Individual
Provider Name (Legal Business Name) : WAYNE A CHRISTENSON JR. M.D.
Provider Business Mailing Address
First Line : 1485 M 139
Second Line :
City : BENTON HARBOR
State : MI
Zip : 49022-5711
Country : US
Telephone Number : 269-925-0585
Fax Number :
Provider Business Practice Location Address
First Line : 1485 M 139
Second Line :
City : BENTON HARBOR
State : MI
Zip : 49022-5711
Country : US
Telephone Number : 269-925-0585
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2006
Last Update Date : 10/20/2014

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