Provider Demographics
NPI:1689870032
Name:TATE, KHRISTINE L (MD)
Entity Type:Individual
Prefix:
First Name:KHRISTINE
Middle Name:L
Last Name:TATE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KHRISTINE
Other - Middle Name:L
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:23455 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1908
Mailing Address - Country:US
Mailing Address - Phone:313-438-6094
Mailing Address - Fax:313-438-6132
Practice Address - Street 1:23455 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1908
Practice Address - Country:US
Practice Address - Phone:313-438-6094
Practice Address - Fax:313-438-6132
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine