Provider Demographics
NPI:1598274847
Name:CHRISTOPHER M GENCO, MD, PLLC
Entity Type:Organization
Organization Name:CHRISTOPHER M GENCO, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:GENCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-355-1982
Mailing Address - Street 1:5300 BAY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2517
Mailing Address - Country:US
Mailing Address - Phone:989-797-1400
Mailing Address - Fax:989-797-4077
Practice Address - Street 1:5560 GRATIOT RD STE 1
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-6091
Practice Address - Country:US
Practice Address - Phone:989-355-1982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060626208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty