Provider Demographics
NPI:1215191648
Name:BORN, CHRISTOPHER H (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:H
Last Name:BORN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7169 KALAMAZOO AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-8146
Mailing Address - Country:US
Mailing Address - Phone:616-266-9100
Mailing Address - Fax:616-266-9200
Practice Address - Street 1:7169 KALAMAZOO AVE SE STE 100
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316
Practice Address - Country:US
Practice Address - Phone:616-266-9100
Practice Address - Fax:616-266-9200
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200Z800130OtherBCBS GROUP