Provider Demographics
NPI:1013103811
Name:GREEN, CHRISTOPHER CANFIELD (MD, PHD, FAAFS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:CANFIELD
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD, PHD, FAAFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50723 HARBOUR VIEW DR S
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-4347
Mailing Address - Country:US
Mailing Address - Phone:586-876-5680
Mailing Address - Fax:586-725-4865
Practice Address - Street 1:50723 HARBOUR VIEW DR S
Practice Address - Street 2:MED:FOR, INC
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-4347
Practice Address - Country:US
Practice Address - Phone:586-876-5680
Practice Address - Fax:586-725-4865
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-15
Last Update Date:2014-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010877892085D0003X, 209800000X, 207Q00000X
NM79-166209800000X
DCMD12109209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine