Provider Demographics
NPI:1033207360
Name:CHRISTIE, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:CHRISTIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4017
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39535-4017
Mailing Address - Country:US
Mailing Address - Phone:228-818-0025
Mailing Address - Fax:228-818-0027
Practice Address - Street 1:2113 GOVERNMENT ST
Practice Address - Street 2:BLDG I-4
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564
Practice Address - Country:US
Practice Address - Phone:228-818-0025
Practice Address - Fax:228-818-0027
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16928207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00122660Medicaid
H01271Medicare UPIN
MS160000561Medicare ID - Type Unspecified