Healthcare Provider Details

I. General information

NPI: 1053391144
Provider Name (Legal Business Name): CHRISTOPHER A MANGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 LONE OAK RD
PADUCAH KY
42003-7901
US

IV. Provider business mailing address

PO BOX 636961
CINCINNATI OH
45263-6961
US

V. Phone/Fax

Practice location:
  • Phone: 270-444-2150
  • Fax: 270-444-2985
Mailing address:
  • Phone: 513-981-5130
  • Fax: 513-981-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number36844
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01045621
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01045624A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: