Provider Demographics
NPI:1386620854
Name:CALTOUM, CHRISTINE B (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:B
Last Name:CALTOUM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:705 RILEY HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5218
Practice Address - Country:US
Practice Address - Phone:317-274-1174
Practice Address - Fax:317-274-7197
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44654207X00000X
IN01063874A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000533753OtherANTHEM PTAN
IN200871530Medicaid
MN432885000Medicaid
MN200001943Medicare PIN
INP01174665Medicare PIN
IN194850FFMedicare PIN
MN432885000Medicaid