Provider Demographics
NPI:1164830048
Name:CARL CHRISTENSEN MD PLLC
Entity Type:Organization
Organization Name:CARL CHRISTENSEN MD PLLC
Other - Org Name:CHRISTENSEN RECOVERY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:WOODROW
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-218-5317
Mailing Address - Street 1:2370 LEFORGE RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-9638
Mailing Address - Country:US
Mailing Address - Phone:734-448-0226
Mailing Address - Fax:313-447-2244
Practice Address - Street 1:2370 LEFORGE RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-9638
Practice Address - Country:US
Practice Address - Phone:734-448-0226
Practice Address - Fax:313-447-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048048207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty