Provider Demographics
NPI:1235162702
Name:ALLAN, CHRISTIAN ELLSWORTH (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:ELLSWORTH
Last Name:ALLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S CRAPO ST
Mailing Address - Street 2:SUITE L
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2961
Mailing Address - Country:US
Mailing Address - Phone:989-772-1213
Mailing Address - Fax:989-772-7147
Practice Address - Street 1:211 S CRAPO ST
Practice Address - Street 2:SUITE L
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2961
Practice Address - Country:US
Practice Address - Phone:989-772-1213
Practice Address - Fax:989-772-7147
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042647207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3173285Medicaid
MIB47930Medicare UPIN
MI3173285Medicaid