Basic Information
| Provider Information | |||||||||
| NPI: | 1962478503 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHRISTENSEN | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5330 N OAK TRFY | ||||||||
| Address2: | STE 201 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641184699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164540666 | ||||||||
| FaxNumber: | 8164541694 | ||||||||
| Practice Location | |||||||||
| Address1: | 5330 N OAK TRFY | ||||||||
| Address2: | STE 201 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641184699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164540666 | ||||||||
| FaxNumber: | 8164541694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 09/09/2011 | ||||||||
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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 | 207Y00000X | R5N03 | MO | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 040009701 | 01 | MO | RAILROAD MEDICARE | OTHER | 040009994 | 01 | KS | RAILROAD MEDICARE | OTHER |