Provider Demographics
NPI:1194725481
Name:ENGLEBERT, CHRISTINA (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:ENGLEBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:V
Other - Last Name:CIANNOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1655 W. MEQUON ROAD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3230
Mailing Address - Country:US
Mailing Address - Phone:262-240-9744
Mailing Address - Fax:262-240-9745
Practice Address - Street 1:1655 W. MEQUON ROAD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3230
Practice Address - Country:US
Practice Address - Phone:262-240-9744
Practice Address - Fax:262-240-9745
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41361208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34095300Medicaid
WI34095300Medicaid