Provider Demographics
NPI:1043215775
Name:EVILSIZER, CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:EVILSIZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:
Other - Last Name:EVILSIZER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8890 N UNION BLVD
Mailing Address - Street 2:STE 160
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7799
Mailing Address - Country:US
Mailing Address - Phone:719-365-9950
Mailing Address - Fax:719-365-9969
Practice Address - Street 1:1400 E BOULDER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5533
Practice Address - Country:US
Practice Address - Phone:719-365-1292
Practice Address - Fax:719-365-6997
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36511207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01365113Medicaid
C482698Medicare PIN
CO01365113Medicaid
C809009Medicare PIN
COG72454Medicare UPIN