MEDICARE: DR. CHRISTIAN ALEXANDER ZELLNER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036123527	IL
2	207RI0011X	Interventional Cardiology Physician	036123527	IL
3	207UN0901X	Nuclear Cardiology Physician	036123527	IL
4	207RC0000X	Cardiovascular Disease Physician	036123527	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972501948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTIAN ALEXANDER ZELLNER M.D.

Provider Business Mailing Address
First Line	:	1025 S 6TH ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703-2403
Country	:	US
Telephone Number	:	217-528-7541
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 59TH ST W STE 4200
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34209-4687
Country	:	US
Telephone Number	:	941-794-3999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	01/13/2022

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