Provider Demographics
NPI:1851499065
Name:RICHARDSON, CHRISTINA A (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:A
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3988 W ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-9200
Mailing Address - Country:US
Mailing Address - Phone:231-935-0860
Mailing Address - Fax:231-935-0860
Practice Address - Street 1:3988 W ROYAL DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-9200
Practice Address - Country:US
Practice Address - Phone:231-935-0860
Practice Address - Fax:231-935-0860
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013386208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2553310924OtherBCBS INDIVIDUAL PIN
MI5194195Medicaid
MI2553310924OtherBCBS INDIVIDUAL PIN