Provider Demographics
NPI:1326080102
Name:CHRISTIANSEN, JAMES LEE
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LEE
Last Name:CHRISTIANSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 WEST FAIR AVE
Mailing Address - Street 2:STE 334
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855
Mailing Address - Country:US
Mailing Address - Phone:906-225-3870
Mailing Address - Fax:906-225-4861
Practice Address - Street 1:1414 WEST FAIR AVE
Practice Address - Street 2:STE 334
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-225-3870
Practice Address - Fax:906-225-4861
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010596302080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3505200821OtherBLUE CROSS BLUE SHIELD
MI2858255Medicaid
E03956Medicare UPIN
MI2858255Medicaid