Healthcare Provider Details

I. General information

NPI: 1821098302
Provider Name (Legal Business Name): CHRISTIAN D. SCHUNN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 E SUNFLOWER RD STE 100B
CLEVELAND MS
38732-2828
US

IV. Provider business mailing address

810 E SUNFLOWER RD
CLEVELAND MS
38732-2800
US

V. Phone/Fax

Practice location:
  • Phone: 662-579-3484
  • Fax: 662-579-3485
Mailing address:
  • Phone: 662-579-3484
  • Fax: 662-579-3485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number010123820
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number19959
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number19959
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0101-238200
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number77788
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0101238200
License Number StateVA
# 7
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number29684
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: