Provider Demographics
NPI:1013999101
Name:BEISENHERZ, CHRISTOPH KLAUS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPH
Middle Name:KLAUS
Last Name:BEISENHERZ
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 1:3 MEDICAL PLAZA DR STE 140
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3088
Mailing Address - Country:US
Mailing Address - Phone:916-865-1400
Mailing Address - Fax:
Practice Address - Street 1:3 MEDICAL PLAZA DR STE 140
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3088
Practice Address - Country:US
Practice Address - Phone:916-865-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA040964207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG12723Medicare UPIN
CA00A409640Medicare PIN
CA001707Medicare ID - Type Unspecified