Provider Demographics
NPI:1700858487
Name:DEWEY, CHRISTINA ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:ELAINE
Last Name:DEWEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:ELAINE
Other - Last Name:HINMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4500 XERXES AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1419
Mailing Address - Country:US
Mailing Address - Phone:612-730-9300
Mailing Address - Fax:612-500-4813
Practice Address - Street 1:4500 XERXES AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-1419
Practice Address - Country:US
Practice Address - Phone:612-730-9300
Practice Address - Fax:612-500-4813
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43301208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN142968OtherUCARE
MN295J4HIOtherBLUE CROSS BLUE SHIELD
MN051614700Medicaid
MN1202287OtherMEDICA
MNCP9041032171OtherPREFERRED ONE
MN051614700Medicaid
MN142968OtherUCARE