Provider Demographics
NPI:1912182494
Name:BRADD K CHRISTENSEN M.D.,P.C.
Entity Type:Organization
Organization Name:BRADD K CHRISTENSEN M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRADD
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PC
Authorized Official - Phone:801-272-4249
Mailing Address - Street 1:1377 E 3900 S
Mailing Address - Street 2:STE 104
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1476
Mailing Address - Country:US
Mailing Address - Phone:801-272-4249
Mailing Address - Fax:801-272-4262
Practice Address - Street 1:1377 E 3900 S
Practice Address - Street 2:STE 104
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1476
Practice Address - Country:US
Practice Address - Phone:801-272-4249
Practice Address - Fax:801-272-4262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT165695-1205261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD07350Medicare UPIN