Provider Demographics
NPI:1992702492
Name:PENN, CHRISTOPHER C (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:C
Last Name:PENN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:325 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1360
Mailing Address - Country:US
Mailing Address - Phone:785-505-2988
Mailing Address - Fax:785-505-5228
Practice Address - Street 1:4525 W 6TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4815
Practice Address - Country:US
Practice Address - Phone:785-505-5160
Practice Address - Fax:785-505-5282
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2023-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0424078207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100272900BMedicaid
KSG37775Medicare UPIN