Provider Demographics
NPI:1720058043
Name:MOERTEL, CHRISTOPHER L (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:L
Last Name:MOERTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 484
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-2778
Mailing Address - Fax:612-626-2815
Practice Address - Street 1:2450 RIVERSIDE AVE.
Practice Address - Street 2:EAST BUILDING, NINTH FLOOR
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454
Practice Address - Country:US
Practice Address - Phone:612-365-8100
Practice Address - Fax:651-220-6005
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN313212080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN593302100Medicaid
370002640Medicare ID - Type Unspecified
D98317Medicare UPIN