Provider Demographics
NPI:1467453613
Name:CHRISTOPHER, INDUMATHI (MD)
Entity type:Individual
Prefix:DR
First Name:INDUMATHI
Middle Name:
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 E. REDSTONE AVE.
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539
Mailing Address - Country:US
Mailing Address - Phone:850-682-6320
Mailing Address - Fax:850-682-6339
Practice Address - Street 1:131 E. REDSTONE AVE.
Practice Address - Street 2:SUITE 107
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539
Practice Address - Country:US
Practice Address - Phone:850-682-6320
Practice Address - Fax:850-682-6339
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417048207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274400700Medicaid
PA0019049700002Medicaid
PA0019049700002Medicaid
PA060727NMRMedicare ID - Type Unspecified
PAH68574Medicare UPIN