Provider Demographics
NPI:1720079528
Name:FUNK, CHRISTOPHER (DPM)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:FUNK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6236
Mailing Address - Country:US
Mailing Address - Phone:801-505-0821
Mailing Address - Fax:801-505-0803
Practice Address - Street 1:3130 S HIGHLAND DR STE B4
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3095
Practice Address - Country:US
Practice Address - Phone:801-253-6886
Practice Address - Fax:385-900-5928
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0542213ES0103X
IDP-289213ES0103X
UT374325-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7156240OtherAETNA
AZ1Z5936OtherHEALTHNET
AZ0273985001OtherCIGNA
UT374328-0501OtherLICENSE
AZ480032647OtherRAILROAD MEDICARE
AZAZ0194180OtherBLUE CROSS BLUE SHIELD
AZ480032647OtherRAILROAD MEDICARE
AZU85515Medicare UPIN