Provider Demographics
NPI:1235123175
Name:DAOUD, CHRISTINA CHILDRESS (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:CHILDRESS
Last Name:DAOUD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:356 E CHICAGO ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-2057
Mailing Address - Country:US
Mailing Address - Phone:517-278-8241
Mailing Address - Fax:517-279-0049
Practice Address - Street 1:356 E CHICAGO ST
Practice Address - Street 2:SUITE A
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2057
Practice Address - Country:US
Practice Address - Phone:517-278-8241
Practice Address - Fax:517-279-0049
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3353926-11Medicaid
MI114528160Medicaid