Provider Demographics
NPI:1346409463
Name:MICHAEL, CHRISTINA ADEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:ADEL
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:CHRISTINA
Other - Middle Name:ADEL
Other - Last Name:SIDKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10301 HAGEN RANCH RD # B5
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3724
Mailing Address - Country:US
Mailing Address - Phone:561-244-7720
Mailing Address - Fax:561-244-7724
Practice Address - Street 1:10301 HAGEN RANCH RD STE B-5
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437
Practice Address - Country:US
Practice Address - Phone:561-244-7720
Practice Address - Fax:561-244-7724
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121957207RC0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06872532Medicaid
LA2105388Medicaid
LA2105388Medicaid