Provider Demographics
NPI:1942264551
Name:CHRISTIANSEN, SIDNEY GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:GEORGE
Last Name:CHRISTIANSEN
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:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-817-3000
Mailing Address - Fax:573-876-6950
Practice Address - Street 1:812 KEENE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6633
Practice Address - Country:US
Practice Address - Phone:573-817-3000
Practice Address - Fax:573-876-6950
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8683207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO156282OtherBLUE CHOICE
MO156282OtherBLUE SHIELD
MO201090024Medicaid
MOP00415543Medicare PIN
MO201090024Medicaid
MO156282OtherBLUE CHOICE
MO938521109Medicare PIN
MO156282OtherBLUE SHIELD