Provider Demographics
NPI:1942314257
Name:CHRISTENSEN, MARK HALGER (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:HALGER
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-1871
Mailing Address - Country:US
Mailing Address - Phone:815-485-0760
Mailing Address - Fax:815-463-6138
Practice Address - Street 1:250 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-1871
Practice Address - Country:US
Practice Address - Phone:815-485-0760
Practice Address - Fax:815-463-6138
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF98614Medicare UPIN
209815Medicare ID - Type Unspecified