Healthcare Provider Details

I. General information

NPI: 1497911325
Provider Name (Legal Business Name): CHRISTOPHER JOHN OWENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 DORCHESTER CT STE A
GOSHEN IN
46526-6819
US

IV. Provider business mailing address

1824 DORCHESTER CT STE A
GOSHEN IN
46526-6819
US

V. Phone/Fax

Practice location:
  • Phone: 574-534-2548
  • Fax: 574-534-3622
Mailing address:
  • Phone: 574-534-2548
  • Fax: 574-534-3622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01074211A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: