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NPI Code Detail

MEDICARE: CHRISTOPHER P VONHAKE DO

MEDICARE: CHRISTOPHER P VONHAKE DO
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
1207Y00000XOtolaryngology Physician036073211IL
2207Y00000XOtolaryngology Physician02004335AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3214881OTHERILMEDICARE GROUP PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689661183
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER P VONHAKE DO
Provider Business Mailing Address
First Line : 2601 W MAIN ST
Second Line :
City : CARBONDALE
State : IL
Zip : 62901-1031
Country : US
Telephone Number : 618-549-5361
Fax Number : 618-351-4878
Provider Business Practice Location Address
First Line : 2601 W MAIN ST
Second Line :
City : CARBONDALE
State : IL
Zip : 62901-1031
Country : US
Telephone Number : 618-549-5361
Fax Number : 618-351-4878
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2005
Last Update Date : 02/01/2017

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Directions to “ CHRISTOPHER P VONHAKE DO” Practice Location

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