Provider Demographics
NPI:1295075794
Name:MCMAHON, CHRISTOPHER M (PA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 LAKE LANSING RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3798
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:311 E WARWICK DR
Practice Address - Street 2:SUITE A
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1088
Practice Address - Country:US
Practice Address - Phone:989-463-4976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006616363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical