Provider Demographics
NPI:1992702096
Name:POWERS, CHRISTOPHER DENNIS (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DENNIS
Last Name:POWERS
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 1:8840 COMMERCE PARK PL STE E
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 N WABASH AVE STE 110
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2677
Practice Address - Country:US
Practice Address - Phone:765-664-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045491A207R00000X
IN01045491207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000677290OtherANTHEM BCBS
IN257270010OtherMEDICARE PTAN
IN565800021OtherMEDICARE PTAN
IN941030014OtherMEDICARE PTAN
IN200092170Medicaid
IN941030014OtherMEDICARE PTAN
IN200092170Medicaid
IN257270010OtherMEDICARE PTAN