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NPI Code Detail

MEDICARE: MR. CHRISTOPHER C STEPHENSON PA-C

MEDICARE: MR. CHRISTOPHER C STEPHENSON PA-C
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
1363A00000XPhysician Assistant10000433AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00180423OTHERINRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000340097OTHERINBLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number : 1063411098
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHRISTOPHER C STEPHENSON PA-C
Provider Business Mailing Address
First Line : 5633 RELIABLE PKWY
Second Line :
City : CHICAGO
State : IL
Zip : 60686-0056
Country : US
Telephone Number : 260-969-1950
Fax Number : 260-918-2137
Provider Business Practice Location Address
First Line : 2401 W UNIVERSITY AVE
Second Line :
City : MUNCIE
State : IN
Zip : 47303-3428
Country : US
Telephone Number : 260-969-1950
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2005
Last Update Date : 02/17/2010

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