Healthcare Provider Details

I. General information

NPI: 1871547497
Provider Name (Legal Business Name): CHRISTOPHER J MCDOUGLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 BARNHILL DR
INDIANAPOLIS IN
46202-5128
US

IV. Provider business mailing address

550 N MERIDIAN ST STE 114
INDIANAPOLIS IN
46204-1207
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-3960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01047650
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number01047650
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: