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General NPI Number Information
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NPI Number | 1306101092
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Entity Type | Individual
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Provider Name | CHRISTOPHER ALAN DEFALCO M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 1400 N RITTER AVE STE 351
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City | INDIANAPOLIS
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State | IN
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Zip | 46219
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Country | US
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Telephone | 317-355-7375
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Fax | 317-355-9215
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Provider Business Mailing Address
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Address Line | 6626 E 75TH ST STE 500
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2890
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 01079933A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 01079933A
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License Number State | IN
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