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1235387713

NPI Code Detail

MEDICARE: CHRISTOPHER JON ANZEVENO MD

MEDICARE: CHRISTOPHER JON ANZEVENO MD

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
1	207R00000X	Internal Medicine Physician	11013341A	IN
2	207R00000X	Internal Medicine Physician	66561	MN
3	207RB0002X	Obesity Medicine (Internal Medicine) Physician	35.149888	OH
4	207R00000X	Internal Medicine Physician	01069170A	IN

General Provider Information

NPI Number	:	1235387713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER JON ANZEVENO MD

Provider Business Mailing Address
First Line	:	17840 BAGLEY RD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3401
Country	:	US
Telephone Number	:	440-531-6000
Fax Number	:	440-531-6195

Provider Business Practice Location Address
First Line	:	17840 BAGLEY RD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3401
Country	:	US
Telephone Number	:	440-531-6000
Fax Number	:	440-531-6195

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2008
Last Update Date	:	09/10/2024

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Directions to “ CHRISTOPHER JON ANZEVENO MD” Practice Location

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