Provider Demographics
NPI:1881691178
Name:ERTL, CHRISTIAN WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:WILLIAM
Last Name:ERTL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1282
Mailing Address - Country:US
Mailing Address - Phone:269-337-6260
Mailing Address - Fax:269-337-6441
Practice Address - Street 1:1000 OAKLAND DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1282
Practice Address - Country:US
Practice Address - Phone:269-337-6260
Practice Address - Fax:269-337-6530
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093343208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1881691178Medicaid
2386462OtherAETNA
149696OtherPREFERRED ONE HUSKY
010036846CT01OtherBC/BS
MI1417961137OtherBCBSM - BRONSON
03684601OtherCONNECTICARE
00136846501OtherBLUE CARE FAMILY PLAN
0V7800OtherHEALTHNET
P984485OtherOXFORD
020001475OtherMEDICARE
061596829OtherCIGNA HEALTH PLAN
1740406OtherUNITED HEALTHCARE
MIM97250024Medicare PIN
149696OtherPREFERRED ONE HUSKY
0V7800OtherHEALTHNET