Provider Demographics
NPI:1336137264
Name:CONLIN, CHRISTOPHER J (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:CONLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6590 ANDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2794
Mailing Address - Country:US
Mailing Address - Phone:248-623-1694
Mailing Address - Fax:
Practice Address - Street 1:G3239 BEECHER RD
Practice Address - Street 2:SUITE F
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3616
Practice Address - Country:US
Practice Address - Phone:810-733-6780
Practice Address - Fax:810-733-8871
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064214207U00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4458440Medicaid
MI4459240Medicaid
MI4458468Medicaid
MI4458459Medicaid
MI4458477Medicaid
MI4458486Medicaid
MIG52164Medicare UPIN