Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 4301048048 | MI |
N | 207VG0400X | Gynecologist | 4301048048 | MI |
NPI | 1598703621 |
---|---|
Provider Name | Carl Woodrow Christensen |
First Address | Ypsilanti, MI 48197-1104 |
Second Address | Ypsilanti, MI 48197-1104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 07/11/2012 |