MEDICARE: DR. CHRISTOPHER DANIEL FEDORUK MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	M0719	TX

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	8AC843	OTHER	TX	BCBSTX PROVIDER NO

NPI Number	:	1790899953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER DANIEL FEDORUK MD

Provider Business Mailing Address
First Line	:	33910 THOUSAND OAK BLVD
Second Line	:
City	:	MAGNOLIA
State	:	TX
Zip	:	77354-6268
Country	:	US
Telephone Number	:	281-259-7286
Fax Number	:	281-259-7286

Provider Business Practice Location Address
First Line	:	18951 N MEMORIAL DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77338-4217
Country	:	US
Telephone Number	:	281-540-6453
Fax Number	:	281-540-7393

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/02/2009

18951 N MEMORIAL DR STE 103W
HUMBLE, TX
77338-4217

Practice Phone: 281-540-8409
Practice Fax: