Provider Demographics
NPI:1104385145
Name:ALCORN, CHRISTOPHER PATRICK (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:PATRICK
Last Name:ALCORN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-559-9411
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:2355 POPLAR LEVEL RD STE 301
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1388
Practice Address - Country:US
Practice Address - Phone:502-559-3636
Practice Address - Fax:502-636-5137
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY05271207R00000X, 207RE0101X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program