Provider Demographics
NPI:1588754667
Name:CHRISTENSEN, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 E ROYALL PL
Mailing Address - Street 2:#601
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1869
Mailing Address - Country:US
Mailing Address - Phone:414-328-7146
Mailing Address - Fax:
Practice Address - Street 1:1550 E ROYALL PL
Practice Address - Street 2:#601
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-1869
Practice Address - Country:US
Practice Address - Phone:414-328-7146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084833207R00000X
WI56845207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL011546OtherHEALTH ALLIANCE MEDICAL
IL036084833Medicaid
WI100022869Medicaid
IL9815737OtherBLUE CROSS BLUE SHIELD
IL036084833Medicaid
ILL25856Medicare PIN
IL110074945Medicare ID - Type UnspecifiedRAILROAD MEDICARE