Provider Demographics
NPI:1447482252
Name:CHRISTIANSEN, WADE A (DPM)
Entity type:Individual
Prefix:
First Name:WADE
Middle Name:A
Last Name:CHRISTIANSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 N 1200 E STE 103
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2255
Mailing Address - Country:US
Mailing Address - Phone:801-995-0898
Mailing Address - Fax:801-766-6022
Practice Address - Street 1:179 N 1200 E STE 103
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2255
Practice Address - Country:US
Practice Address - Phone:801-995-0898
Practice Address - Fax:801-766-6022
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8324411-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery