Provider Demographics
NPI:1851584973
Name:STEVEN D CHRISTESEN MD PA
Entity Type:Organization
Organization Name:STEVEN D CHRISTESEN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHRISTESEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:941-624-3600
Mailing Address - Street 1:PO BOX 495839
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-5839
Mailing Address - Country:US
Mailing Address - Phone:941-624-3600
Mailing Address - Fax:941-624-0700
Practice Address - Street 1:3440 TAMIAMI TRL
Practice Address - Street 2:STE 2
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8134
Practice Address - Country:US
Practice Address - Phone:941-624-3600
Practice Address - Fax:941-624-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66791207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376393500Medicaid
FL25941OtherBCBS FL
FL25941OtherBCBS FL
FLAE310Medicare PIN