Basic Information
Provider Information
NPI: 1225150352
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VEENSTRA
FirstName: CHRISTINE
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3621 SOUTH STATE STREET
Address2: 700 KMS PLACE
City: ANN ARBOR
State: MI
PostalCode: 48108
CountryCode: US
TelephoneNumber: 7349362047
FaxNumber:  
Practice Location
Address1: 1500 E. MEDICAL CENTER DR.
Address2: B1 FLOOR CANCER RECP C
City: ANN ARBOR
State: MI
PostalCode: 481095912
CountryCode: US
TelephoneNumber: 7346478902
FaxNumber: 7346454484
Other Information
ProviderEnumerationDate: 04/06/2007
LastUpdateDate: 01/16/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003X4301086203MIN Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
390200000X4301086203MIN Student, Health CareStudent in an Organized Health Care Education/Training Program 
207R00000X4301086203MIN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RX0202X4301086203MIY Allopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology

No ID Information.


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