Provider Demographics
NPI:1710417159
Name:BEATTIE, CHRISTINA SAMAAN (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:SAMAAN
Last Name:BEATTIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:SAMAAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1 GENESYS PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8065
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 GENESYS PKWY
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8065
Practice Address - Country:US
Practice Address - Phone:810-606-5981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101023442207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0102207258OtherSTATE OF VIRGINIA
SCDO89694OtherSTATE OF SOUTH CAROLINA
PAOS022056OtherSTATE OF PA
MI5101023442OtherSTATE OF MICHIGAN