Provider Demographics
NPI:1962478503
Name:CHRISTENSEN, ERIC C (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:C
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 1:5330 N OAK TRFY
Mailing Address - Street 2:STE 201
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-4699
Mailing Address - Country:US
Mailing Address - Phone:816-454-0666
Mailing Address - Fax:816-454-1694
Practice Address - Street 1:5330 N OAK TRFY
Practice Address - Street 2:STE 201
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4699
Practice Address - Country:US
Practice Address - Phone:816-454-0666
Practice Address - Fax:816-454-1694
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5N03207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO040009701OtherRAILROAD MEDICARE
KS040009994OtherRAILROAD MEDICARE
MOG262205BMedicare PIN
E55273Medicare UPIN
KSG262205AMedicare PIN