Basic Information
| Provider Information | |||||||||
| NPI: | 1518906080 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOAH | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4525 N M 37 HWY | ||||||||
| Address2: | STE M | ||||||||
| City: | MIDDLEVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493338167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2697954434 | ||||||||
| FaxNumber: | 2697954271 | ||||||||
| Practice Location | |||||||||
| Address1: | 4525 N M 37 HWY | ||||||||
| Address2: | STE M | ||||||||
| City: | MIDDLEVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493338167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2697954434 | ||||||||
| FaxNumber: | 2697954271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 03/17/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | CN58114 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 900002829 | 01 | MI | PRIORITY HEALTH | OTHER | 0080023 | 01 | MI | BC/BS OF MICHIGAN | OTHER | 15994 | 01 | MI | HEALTH PLAN OF MICHIGAN | OTHER | 4260367 | 05 | MI | MEDICAID |