Provider Demographics
NPI:1326848631
Name:JERDINE, CHRISTOPHER DANIEL
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:DANIEL
Last Name:JERDINE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11356 MARION
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-2017
Mailing Address - Country:US
Mailing Address - Phone:248-275-4279
Mailing Address - Fax:
Practice Address - Street 1:11356 MARION
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-2017
Practice Address - Country:US
Practice Address - Phone:248-275-4279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI38AGU5343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)