Healthcare Provider Details

I. General information

NPI: 1376760827
Provider Name (Legal Business Name): CHRISTOPHER M. ANNIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 CALIFORNIA RD
ELKHART IN
46514-1228
US

IV. Provider business mailing address

2310 CALIFORNIA RD STE A
ELKHART IN
46514-1228
US

V. Phone/Fax

Practice location:
  • Phone: 574-264-0791
  • Fax: 574-262-9650
Mailing address:
  • Phone: 574-264-0791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number01069770A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0169770A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number01069770A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: