Healthcare Provider Details

I. General information

NPI: 1033962485
Provider Name (Legal Business Name): MARTIN CHRISTOPHER JAMES WINKLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S 7TH ST
VINCENNES IN
47591-1038
US

IV. Provider business mailing address

112 N VINE ST
HAUBSTADT IN
47639-8122
US

V. Phone/Fax

Practice location:
  • Phone: 812-882-5220
  • Fax:
Mailing address:
  • Phone: 812-486-8804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10004451A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: