Provider Demographics
NPI:1083029235
Name:SACCONE, CHRISTOPHER CARL (DPM)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:CARL
Last Name:SACCONE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 EDSEL LN NW STE 3
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-3008
Mailing Address - Country:US
Mailing Address - Phone:812-225-5480
Mailing Address - Fax:812-225-5481
Practice Address - Street 1:1995 EDSEL LN NW STE 3
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-3008
Practice Address - Country:US
Practice Address - Phone:812-225-5480
Practice Address - Fax:812-225-5481
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001246A213ES0103X
KY243992213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300004224Medicaid
KY7100466340Medicaid