Provider Demographics
NPI:1528009123
Name:CHRISTENSEN, JAMES M (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:CHRISTENSEN
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 1:1027 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3409
Mailing Address - Country:US
Mailing Address - Phone:218-847-5611
Mailing Address - Fax:218-847-0881
Practice Address - Street 1:1027 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3409
Practice Address - Country:US
Practice Address - Phone:218-847-5611
Practice Address - Fax:218-847-0881
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41844207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN11933Medicaid
FM142001OtherUCARE #
MNDA9031026964OtherPREFERRED ONE #
MNMN200041OtherLHS/BANNERHEALTH #
FM0701534OtherMEDICA #
MNHP38296OtherHEALTHPARTNERS #
MN712516000Medicaid
MN900594OtherAMERICA'S PPO/ARAZ #
MN0701535OtherMEDICA #
MN18017OtherNDBS #
MN64D98CHOtherMNBS #
FMDA9041026964OtherPREFERRED ONE #
MN17923OtherNDBS #
MN69DOCHOtherMNBS #
MN160049831Medicare ID - Type UnspecifiedRR MEDICARE #
MNMN200041OtherLHS/BANNERHEALTH #
FM142001OtherUCARE #