Basic Information
| Provider Information | |||||||||
| NPI: | 1881691178 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERTL | ||||||||
| FirstName: | CHRISTIAN | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 OAKLAND DR | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490081282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693376260 | ||||||||
| FaxNumber: | 2693376441 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 OAKLAND DR | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490081282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693376260 | ||||||||
| FaxNumber: | 2693376530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2005 | ||||||||
| LastUpdateDate: | 02/15/2012 | ||||||||
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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 | 208600000X | 4301093343 | MI | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1881691178 | 05 | MI | MEDICAID | 2386462 | 01 | AETNA | OTHER | 149696 | 01 | PREFERRED ONE HUSKY | OTHER | 010036846CT01 | 01 | BC/BS | OTHER | 1417961137 | 01 | MI | BCBSM - BRONSON | OTHER | 03684601 | 01 | CONNECTICARE | OTHER | 00136846501 | 01 | BLUE CARE FAMILY PLAN | OTHER | 0V7800 | 01 | HEALTHNET | OTHER | P984485 | 01 | OXFORD | OTHER | 020001475 | 01 | MEDICARE | OTHER | 061596829 | 01 | CIGNA HEALTH PLAN | OTHER | 1740406 | 01 | UNITED HEALTHCARE | OTHER |