1295863108 NPI number — DR. CHRISTOPHER J DULL MD, JD

Table of content: DR. CHRISTOPHER J DULL MD, JD (NPI 1295863108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295863108 NPI number — DR. CHRISTOPHER J DULL MD, JD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DULL
Provider First Name:
CHRISTOPHER
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, JD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295863108
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9755 SOARING HAWK CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZIONSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46077-9789
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-483-1270
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1650 W OAK ST STE 207
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZIONSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46077-3836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-995-9256
Provider Business Practice Location Address Fax Number:
615-265-0805
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  39896 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 01076418A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 300007026 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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