Provider Demographics
NPI:1598703621
Name:CHRISTENSEN, CARL WOODROW (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:WOODROW
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4870 W CLARK RD STE 201
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1104
Mailing Address - Country:US
Mailing Address - Phone:734-434-6600
Mailing Address - Fax:313-447-2244
Practice Address - Street 1:4870 W CLARK RD STE 201
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1104
Practice Address - Country:US
Practice Address - Phone:734-434-6600
Practice Address - Fax:313-447-2244
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301048048207VG0400X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology