Provider Demographics
NPI:1316908437
Name:CHAMPION, CHRISTOPHER S (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:S
Last Name:CHAMPION
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 1:840 EAST UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2304
Mailing Address - Country:US
Mailing Address - Phone:515-265-4211
Mailing Address - Fax:515-309-5993
Practice Address - Street 1:840 EAST UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2304
Practice Address - Country:US
Practice Address - Phone:515-265-4211
Practice Address - Fax:515-309-5993
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-03394207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0215285Medicaid
IA1780767582Medicaid
IAI4399Medicare PIN
IAP00147998Medicare PIN
IA0215285Medicaid
IAH56870Medicare UPIN