Basic Information
| Provider Information | |||||||||
| NPI: | 1073595674 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELSHOLZ | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | AMBER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 LAPEER AVE | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486071208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897596464 | ||||||||
| FaxNumber: | 9893998233 | ||||||||
| Practice Location | |||||||||
| Address1: | 6297 DIXIE HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487229635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897596460 | ||||||||
| FaxNumber: | 9897596465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 04/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301063548 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4761998 | 05 | MI | MEDICAID | 1073595674 | 05 | MI | MEDICAID | 150960 | 01 | GREAT LAKES HEALTH PLAN | OTHER | 321 | 01 | MI | CARE SOURCE OF MICHIGAN | OTHER | 1017365 | 01 | MI | MCLAREN HEALTH PLAN OF MI | OTHER | P00380702 | 01 | MI | RAILROAD MEDICARE | OTHER | 080G310660 | 01 | MI | BLUE CROSS BLUE SHIELD OF MICHIGAN | OTHER | 0980802 | 01 | MI | HEALTHPLUS OF MICHIGAN | OTHER | 381908328 | 01 | PPOM | OTHER | 4671988 | 01 | MOLINA HEALTH CARE OF MI | OTHER | 7606126 | 01 | MI | AETNA | OTHER | 381908328 | 01 | HCAP | OTHER |