Provider Demographics
NPI:1053313692
Name:ANDERSON, CHRISTINA K (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:K
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1200 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:320-252-5131
Mailing Address - Fax:320-240-2118
Practice Address - Street 1:1200 6TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2735
Practice Address - Country:US
Practice Address - Phone:320-252-5131
Practice Address - Fax:320-240-2118
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN44506207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP35615OtherHEALTH PARTNERS
142131OtherU CARE
07 25 2002OtherMMSI
1031188OtherPREFERRED ONE
116094000OtherMEDICAL ASSISTANCE
260J8ANOtherBCBS
0300206OtherMEDICA HEALTH PLANS
070017209OtherRR MEDICARE C11369
MN116094000Medicaid
1652898OtherARAZ GROUP AMERICA'S PPO
1652898OtherARAZ GROUP AMERICA'S PPO
1031188OtherPREFERRED ONE