Provider Demographics
NPI:1639470685
Name:HA, CHRISTINA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:HA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9470 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-5722
Mailing Address - Country:US
Mailing Address - Phone:219-661-3255
Mailing Address - Fax:219-662-3765
Practice Address - Street 1:9470 BROADWAY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-5722
Practice Address - Country:US
Practice Address - Phone:219-661-3255
Practice Address - Fax:219-662-3765
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128610208000000X
IN01070441A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000749426OtherANTHEM TRADITIONAL
IN201044430Medicaid
IN201044430Medicaid