Provider Demographics
NPI:1205920691
Name:CHRISTENSEN, WILLIAM I (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:I
Last Name:CHRISTENSEN
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 1:67780 E PALM CANYON DR
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-5441
Mailing Address - Country:US
Mailing Address - Phone:760-328-5679
Mailing Address - Fax:760-328-6497
Practice Address - Street 1:67780 E PALM CANYON DR
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-5441
Practice Address - Country:US
Practice Address - Phone:760-328-5679
Practice Address - Fax:760-328-6497
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22562207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM13433Medicaid
$$$$$$$$$PMedicare PIN
D43075Medicare UPIN