Provider Demographics
NPI:1255627006
Name:EDWARDS, CHRISTOFER J (PA-C)
Entity type:Individual
Prefix:MR
First Name:CHRISTOFER
Middle Name:J
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:34405 W 12 MILE RD STE 173
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-5605
Mailing Address - Country:US
Mailing Address - Phone:248-957-7999
Mailing Address - Fax:248-957-7997
Practice Address - Street 1:34405 W 12 MILE RD STE 173
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-5605
Practice Address - Country:US
Practice Address - Phone:248-795-7799
Practice Address - Fax:248-957-7997
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA055077363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant