Provider Demographics
NPI:1073192555
Name:SUPINO, CHRISTINA MARIA (DO)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIA
Last Name:SUPINO
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Gender:
Credentials:DO
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Mailing Address - Street 1:275 MICHIGAN ST NE FL 6
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2531
Mailing Address - Country:US
Mailing Address - Phone:616-267-8700
Mailing Address - Fax:
Practice Address - Street 1:275 MICHIGAN ST NE FL 6
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2531
Practice Address - Country:US
Practice Address - Phone:616-267-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-03
Last Update Date:2025-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI51510149612086S0129X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery