Provider Demographics
NPI:1962728626
Name:PACOLD, CHRISTINE (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:PACOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SISTER MARIA LIN
Other - Middle Name:
Other - Last Name:PACOLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2025 W CHEESMAN RD
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-9760
Mailing Address - Country:US
Mailing Address - Phone:989-463-3451
Mailing Address - Fax:989-463-1534
Practice Address - Street 1:2025 W CHEESMAN RD
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-9760
Practice Address - Country:US
Practice Address - Phone:989-463-3451
Practice Address - Fax:989-463-1534
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK278242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B96028OtherBLUE CROSS BLUE SHEILD
MI1962728626Medicaid
MI0B96028OtherBLUE CROSS BLUE SHEILD