Provider Demographics
NPI:1710965207
Name:DAISY, CHRISTOPHER (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:DAISY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38935 ANN ARBOR RD
Mailing Address - Street 2:CREDENTIALING/PAYER CONTRACTING
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3397
Mailing Address - Country:US
Mailing Address - Phone:734-632-0175
Mailing Address - Fax:734-632-0182
Practice Address - Street 1:18101 OAKWOOD BLVD
Practice Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4089
Practice Address - Country:US
Practice Address - Phone:313-593-8780
Practice Address - Fax:313-436-2864
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013225207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0158208395OtherBCBS
CD013225OtherBCBS
MI1710965207Medicaid
MI0158208395OtherBCBS
MI1710965207Medicaid
MIN87430015Medicare ID - Type UnspecifiedPEC SJMM (PHYSICIANS)
MIQ26294339Medicare ID - Type UnspecifiedPEC OKW (PHYSICIANS)
P40540018Medicare PIN