Provider Demographics
NPI:1699662734
Name:CHRISTENSEN, MATTHEW D
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5240 N SHERIDAN RD APT 313
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2592
Mailing Address - Country:US
Mailing Address - Phone:813-777-5680
Mailing Address - Fax:
Practice Address - Street 1:3500 SUNRISE HWY STE 300
Practice Address - Street 2:
Practice Address - City:GREAT RIVER
Practice Address - State:NY
Practice Address - Zip Code:11739-1001
Practice Address - Country:US
Practice Address - Phone:631-665-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program