Provider Demographics
NPI:1467033134
Name:CHRISTIANSEN, LOGAN (DPM)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:CHRISTIANSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1096
Mailing Address - Country:US
Mailing Address - Phone:303-449-2000
Mailing Address - Fax:
Practice Address - Street 1:1400 28TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1096
Practice Address - Country:US
Practice Address - Phone:303-449-2000
Practice Address - Fax:303-449-9475
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN41000438A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery