Provider Demographics
NPI:1003693573
Name:BYK, CHRISTINA ROSEMARIE
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ROSEMARIE
Last Name:BYK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4119 WINTER DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-1395
Mailing Address - Country:US
Mailing Address - Phone:586-804-4348
Mailing Address - Fax:
Practice Address - Street 1:51850 DEQUINDRE RD STE 1
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-2806
Practice Address - Country:US
Practice Address - Phone:586-799-4082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601012028363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant