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NPI Code Detail

MEDICARE: CHRISTOPHER M WING M.D.

MEDICARE: CHRISTOPHER M WING M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician01046594IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000092602OTHERINANTHEM
37991OTHERINPHP
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023063930
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER M WING M.D.
Provider Business Mailing Address
First Line : 3707 NEW VISION DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1702
Country : US
Telephone Number : 260-471-9466
Fax Number : 260-484-5919
Provider Business Practice Location Address
First Line : 3707 NEW VISION DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1702
Country : US
Telephone Number : 260-471-9466
Fax Number : 260-484-5919
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2006
Last Update Date : 01/27/2016

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Directions to “ CHRISTOPHER M WING M.D.” Practice Location

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