Provider Demographics
NPI:1205829405
Name:CHRISTIAN, MICHAL GERALYN (PA C)
Entity Type:Individual
Prefix:
First Name:MICHAL
Middle Name:GERALYN
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 RENAISSANCE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3041
Mailing Address - Country:US
Mailing Address - Phone:405-285-7500
Mailing Address - Fax:405-285-7501
Practice Address - Street 1:1705 RENAISSANCE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3041
Practice Address - Country:US
Practice Address - Phone:405-285-7500
Practice Address - Fax:405-285-7501
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2012-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1430363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200057710AMedicaid
OK200057710AMedicaid
Q44629Medicare UPIN