Provider Demographics
NPI:1881802312
Name:CHRISTIANSEN, CORY G (MD)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:G
Last Name:CHRISTIANSEN
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 1:2751 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-9509
Mailing Address - Country:US
Mailing Address - Phone:319-338-3606
Mailing Address - Fax:319-338-0522
Practice Address - Street 1:2751 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-9509
Practice Address - Country:US
Practice Address - Phone:319-338-3606
Practice Address - Fax:319-338-0522
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA38395207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1881802312Medicaid
IAI75560004OtherMEDICARE PTAN