Individual
MR. CHRISTOPHER J CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
200 STATE AVE, FARIBAULT, MN 55021-6339
(507) 497-3533
Mailing address
2829 UNIVERSITY AVE SE STE 730, MINNEAPOLIS, MN 55414-3279
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10213
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
362495000
—
MN
01
—
P00395174
RAILROAD MEDICARE
MN
Enumeration date
11/22/2006
Last updated
09/13/2024
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