Basic Information
| Provider Information | |||||||||
| NPI: | 1255861472 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ATHENS | ||||||||
| FirstName: | CHRISTIAN | ||||||||
| MiddleName: | MARK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29113 E RIVER RD | ||||||||
| Address2: | |||||||||
| City: | GROSSE ILE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481381940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346262727 | ||||||||
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| Practice Location | |||||||||
| Address1: | 28050 GRAND RIVER AVE | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483365919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484718000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2017 | ||||||||
| LastUpdateDate: | 06/20/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 5101023375 | MI | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.