Provider Demographics
NPI:1992789853
Name:MITCHEM-WALTER, CHRISTINA M (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:MITCHEM-WALTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 TURTLE CREEK CIR
Mailing Address - Street 2:STE F
Mailing Address - City:SWANTON
Mailing Address - State:OH
Mailing Address - Zip Code:43558-8537
Mailing Address - Country:US
Mailing Address - Phone:419-825-5151
Mailing Address - Fax:419-825-5901
Practice Address - Street 1:1 TURTLE CREEK CIR
Practice Address - Street 2:STE F
Practice Address - City:SWANTON
Practice Address - State:OH
Practice Address - Zip Code:43558-8537
Practice Address - Country:US
Practice Address - Phone:419-825-5151
Practice Address - Fax:419-825-5901
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35083188207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2438836Medicaid
OHH95774Medicare UPIN
OH2438836Medicaid