Provider Demographics
NPI:1861450165
Name:CHRISTIAN, KRISTEN M (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:M
Other - Last Name:LUKASIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 WESTFALL RD
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2635
Mailing Address - Country:US
Mailing Address - Phone:585-244-5510
Mailing Address - Fax:585-244-5604
Practice Address - Street 1:900 WESTFALL RD
Practice Address - Street 2:SUITE 3C
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2635
Practice Address - Country:US
Practice Address - Phone:585-244-5510
Practice Address - Fax:585-244-5604
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213179208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355266Medicaid
NY050920000015OtherFIDELIS
NY101802DLOtherPREFERRED CARE
NY11121930OtherCAQH
NYP010213179OtherBLUE CHOICE
NY101802DLOtherPREFERRED CARE
NY00355266Medicaid