Healthcare Provider Details

I. General information

NPI: 1407807449
Provider Name (Legal Business Name): CHRISTOPHER A PRATER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 HADLEY RD
MOORESVILLE IN
46158-1737
US

IV. Provider business mailing address

1801 N WALNUT ST
MUNCIE IN
47303-1953
US

V. Phone/Fax

Practice location:
  • Phone: 317-831-1160
  • Fax: 765-213-3240
Mailing address:
  • Phone: 765-284-0493
  • Fax: 765-213-3240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01060890A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: