Provider Demographics
NPI:1518994011
Name:CHRISTENSEN, CHARLES H (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:H
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1060 S. VAN DYKE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9631
Mailing Address - Country:US
Mailing Address - Phone:989-269-7775
Mailing Address - Fax:989-269-7677
Practice Address - Street 1:1060 S. VAN DYKE
Practice Address - Street 2:SUITE 400
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9631
Practice Address - Country:US
Practice Address - Phone:989-269-7775
Practice Address - Fax:989-269-7677
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015749208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1518994011Medicaid
MI1518994011Medicaid
MT95906OtherBCBS
MI1518994011Medicaid