Provider Demographics
NPI:1528096708
Name:TARDIF, CHRISTOPHER P (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:P
Last Name:TARDIF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 36TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4862
Mailing Address - Country:US
Mailing Address - Phone:772-567-4311
Mailing Address - Fax:772-794-1450
Practice Address - Street 1:3745 11TH CIR
Practice Address - Street 2:SUITE 103
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4837
Practice Address - Country:US
Practice Address - Phone:772-794-9771
Practice Address - Fax:772-794-9773
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67894208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26691OtherBCBS
FL26691VMedicare PIN
G05767Medicare UPIN