Provider Demographics
NPI:1891840914
Name:CHRISTENSEN, BRADD K (MD)
Entity Type:Individual
Prefix:
First Name:BRADD
Middle Name:K
Last Name:CHRISTENSEN
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 1:1377 E 3900 S STE 104
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1492
Mailing Address - Country:US
Mailing Address - Phone:801-272-4249
Mailing Address - Fax:
Practice Address - Street 1:1377 E 3900 S STE 104
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1492
Practice Address - Country:US
Practice Address - Phone:801-272-4249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT165695-1205208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
00001202Medicare ID - Type Unspecified
D07350Medicare UPIN