Provider Demographics
NPI:1285742163
Name:PESAVENTO, CHRISTOPHER BAUER (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:BAUER
Last Name:PESAVENTO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:701 E COUNTY LINE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1072
Mailing Address - Country:US
Mailing Address - Phone:317-215-2833
Mailing Address - Fax:317-215-2838
Practice Address - Street 1:701 E COUNTY LINE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1072
Practice Address - Country:US
Practice Address - Phone:317-215-2833
Practice Address - Fax:317-215-2838
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-09-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01062116A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ2731Medicare PIN
INI65406Medicare UPIN
ININ2731001Medicare PIN