Provider Demographics
NPI:1467728618
Name:VICTORIA, CHRISTINE FAITH (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:FAITH
Last Name:VICTORIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:FAITH
Other - Last Name:LAJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR
Mailing Address - Street 2:PO BOX 0446 LOBBY J
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:49650 CHERRY HILL RD STE 210
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-4859
Practice Address - Country:US
Practice Address - Phone:734-398-7899
Practice Address - Fax:734-398-7895
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-31
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301107191208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics