Provider Demographics
NPI:1790702587
Name:CHRISTIN, GLORIA A (DPM)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:A
Last Name:CHRISTIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 831
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43552-0831
Mailing Address - Country:US
Mailing Address - Phone:734-699-5182
Mailing Address - Fax:419-885-0203
Practice Address - Street 1:1194 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1011
Practice Address - Country:US
Practice Address - Phone:734-699-5182
Practice Address - Fax:419-885-0203
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI001748213E00000X
OH36002682213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
480018804OtherRAILROAD MEDICARE
OH0841030Medicaid
OH0841030Medicaid
U19180Medicare UPIN
OHCH0696263Medicare PIN