Provider Demographics
NPI:1285367441
Name:CHRISTENSEN, MICHAEL DEAN
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DEAN
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3067 S MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:OLIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54880-8163
Mailing Address - Country:US
Mailing Address - Phone:715-566-2640
Mailing Address - Fax:
Practice Address - Street 1:3067 S MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:OLIVER
Practice Address - State:WI
Practice Address - Zip Code:54880-8163
Practice Address - Country:US
Practice Address - Phone:715-566-2640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program