1073595674 NPI number — CHRISTINE AMBER ELSHOLZ MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073595674 NPI number — CHRISTINE AMBER ELSHOLZ MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ELSHOLZ

Provider First Name:

CHRISTINE

Provider Middle Name:

AMBER

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1073595674

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/08/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

501 LAPEER AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SAGINAW

Provider Business Mailing Address State Name:

MI

Provider Business Mailing Address Postal Code:

48607-1208

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

989-759-6464

Provider Business Mailing Address Fax Number:

989-399-8233

Provider First Line Business Practice Location Address:

6297 DIXIE HIGHWAY

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BRIDGEPORT

Provider Business Practice Location Address State Name:

MI

Provider Business Practice Location Address Postal Code:

48722-9635

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

989-759-6460

Provider Business Practice Location Address Fax Number:

989-759-6465

Provider Enumeration Date:

11/18/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  4301063548 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 4761998 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: 1073595674 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: 150960 . This is a "GREAT LAKES HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 321 . This is a "CARE SOURCE OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 1017365 . This is a "MCLAREN HEALTH PLAN OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: P00380702 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 080G310660 . This is a "BLUE CROSS BLUE SHIELD OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 0980802 . This is a "HEALTHPLUS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 381908328 . This is a "PPOM" identifier . This identifiers is of the category "OTHER".
• Identifier: 4671988 . This is a "MOLINA HEALTH CARE OF MI" identifier . This identifiers is of the category "OTHER".
• Identifier: 7606126 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 381908328 . This is a "HCAP" identifier . This identifiers is of the category "OTHER".