Provider Demographics
NPI:1326020272
Name:SMALLEY, CHRISTOPHER M (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:SMALLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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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:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:7440 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219
Practice Address - Country:US
Practice Address - Phone:502-969-0975
Practice Address - Fax:502-969-0081
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY36602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01050143OtherRAILROAD MEDICARE
KY090778OtherSIHO - NCMA
KY000000765744OtherANTHEM - NCMA
KY64059066Medicaid
KY50037759OtherPASSPORT - NCMA - LOUISVILLE
KY50037757OtherPASSPORT - NCMA - BULLITT
KY50037757OtherPASSPORT - NCMA - BULLITT
KY00546078Medicare Oscar/Certification
KYP00275359Medicare PIN
KYP01050143OtherRAILROAD MEDICARE