Provider Demographics
NPI:1750304945
Name:CHRISTY, EDWARD ANTON (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ANTON
Last Name:CHRISTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 N IRISH RD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-2209
Mailing Address - Country:US
Mailing Address - Phone:810-658-2131
Mailing Address - Fax:810-658-3500
Practice Address - Street 1:1032 N IRISH RD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-2209
Practice Address - Country:US
Practice Address - Phone:810-658-2131
Practice Address - Fax:810-658-3500
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEC071230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3446838Medicaid
MIOP41170001Medicare PIN
MI0N93660Medicare ID - Type Unspecified
MI3446838Medicaid