Provider Demographics
NPI:1992069819
Name:CHRISTENSEN, RYAN THOMAS (DO)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:THOMAS
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 S LAPEER RD STE A
Mailing Address - Street 2:
Mailing Address - City:ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-2662
Mailing Address - Country:US
Mailing Address - Phone:248-690-7070
Mailing Address - Fax:313-769-8634
Practice Address - Street 1:2800 S LAPEER RD STE A
Practice Address - Street 2:
Practice Address - City:ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-2662
Practice Address - Country:US
Practice Address - Phone:248-481-2423
Practice Address - Fax:313-769-8634
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019999207P00000X, 207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1992069819OtherNPI
MI1992069819Medicaid