Provider Demographics
NPI:1508131962
Name:WOOD, CHRISTINA GOUGH (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:GOUGH
Last Name:WOOD
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1640 FORT STREET
Mailing Address - Street 2:SUITE D ATTN DENISE
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183
Mailing Address - Country:US
Mailing Address - Phone:734-391-3057
Mailing Address - Fax:734-391-3052
Practice Address - Street 1:23050 WEST RD # MI48183
Practice Address - Street 2:STE 210
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1472
Practice Address - Country:US
Practice Address - Phone:734-362-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2017-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101019862207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H24657OtherBLUE CROSS
MI1457586646OtherGROUP NPI HENRY FORD WYANDOTTE
MIQ24657084Medicare PIN