Provider Demographics
NPI:1265921753
Name:ISHAM, CHRISTOPHER TIMOTHY (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:TIMOTHY
Last Name:ISHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:221 W TROY ST STE 400
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-3903
Mailing Address - Country:US
Mailing Address - Phone:248-844-6100
Mailing Address - Fax:248-844-6102
Practice Address - Street 1:221 W TROY ST STE 400
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-3903
Practice Address - Country:US
Practice Address - Phone:248-844-6100
Practice Address - Fax:248-844-6102
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301506885207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program