Basic Information
| Provider Information | |||||||||
| NPI: | 1861979221 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDOWELL | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | MALLORY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1525 RIDGEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486426425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898356333 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3301 RIDGECREST DR | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486425860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898392290 | ||||||||
| FaxNumber: | 8442734297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2018 | ||||||||
| LastUpdateDate: | 05/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | M234115579517 | MI | Y |
No ID Information.