Provider Demographics
NPI:1780785204
Name:NAGEOTTE, CHRISTIAN G (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:G
Last Name:NAGEOTTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:39450 WEST 12 MILE ROAD
Mailing Address - Street 2:HENRY FORD HEALTH SYSTEM
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-344-2490
Mailing Address - Fax:248-344-2492
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:6777 WEST MAPLE ROAD
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323
Practice Address - Country:US
Practice Address - Phone:248-661-6450
Practice Address - Fax:248-661-6649
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301072658207KA0200X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI453313210Medicaid
CN072658OtherCHAMPUS-CHAMPUS
030H264390OtherBLUE CROSS-BLUE CROSS
CN072658OtherCOMMERCIAL-COMMERCIAL NUMBER
CN072658OtherCOMMERCIAL-COMMERCIAL NUMBER
0H26439013Medicare ID - Type Unspecified