Individual
WAYNE A CHRISTENSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1485 M 139, BENTON HARBOR, MI 49022-5711
(269) 925-0585
Mailing address
1485 M 139, BENTON HARBOR, MI 49022-5711
(269) 925-0585
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01039706A
IN
2084P0804X
Child & Adolescent Psychiatry Physician
01039706A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000203802
ANTHEM
IN
05
—
100382510
—
IN
Enumeration date
06/14/2006
Last updated
10/20/2014
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