Provider Demographics
NPI:1417036005
Name:DEBRANIN, CHRISTIAN O (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:O
Last Name:DEBRANIN
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 1:700 WEST AVE S
Mailing Address - Street 2:PHYSICIAN SERVICES DEPT
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4783
Mailing Address - Country:US
Mailing Address - Phone:608-392-4156
Mailing Address - Fax:608-392-9898
Practice Address - Street 1:800 WEST AVE S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-8806
Practice Address - Country:US
Practice Address - Phone:608-392-9510
Practice Address - Fax:608-392-9860
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45184207RH0003X
KY27870207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34311000Medicaid
KY000000220347OtherANTHEM BCBS
KY6427870800Medicaid
KY830007760Medicare PIN
B29520Medicare UPIN
KY6427870800Medicaid
KY0661961Medicare PIN
WI34311000Medicaid