Basic Information
| Provider Information | |||||||||
| NPI: | 1851584973 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEVEN D CHRISTESEN MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 495839 | ||||||||
| Address2: | |||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339495839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9416243600 | ||||||||
| FaxNumber: | 9416240700 | ||||||||
| Practice Location | |||||||||
| Address1: | 3440 TAMIAMI TRL | ||||||||
| Address2: | STE 2 | ||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339528134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9416243600 | ||||||||
| FaxNumber: | 9416240700 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2007 | ||||||||
| LastUpdateDate: | 08/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | CHRISTESEN | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9416243600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD PA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME66791 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 376393500 | 05 | FL | MEDICAID | 25941 | 01 | FL | BCBS FL | OTHER |