Provider Demographics
NPI:1104931252
Name:FARIS, CHRISTOPHER H (DPM)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:H
Last Name:FARIS
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 1:719 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2637
Mailing Address - Country:US
Mailing Address - Phone:269-684-0166
Mailing Address - Fax:269-684-8034
Practice Address - Street 1:719 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2637
Practice Address - Country:US
Practice Address - Phone:269-684-0166
Practice Address - Fax:269-684-8034
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001162213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1948394Medicaid
MI1948394Medicaid
U23046Medicare UPIN
5115047Medicare PIN