Provider Demographics
NPI:1073513024
Name:BIENIEK, CHRISTOPHER MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:BIENIEK
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:PO BOX 935
Mailing Address - Street 2:188 MEDICAL DRIVE
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-0935
Mailing Address - Country:US
Mailing Address - Phone:573-248-1010
Mailing Address - Fax:573-248-0536
Practice Address - Street 1:188 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6877
Practice Address - Country:US
Practice Address - Phone:573-248-1010
Practice Address - Fax:573-248-0536
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100325207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO002011765OtherMEDICARE PROVIDER NUMBER
MO203450002Medicaid
MO002011765OtherMEDICARE PROVIDER NUMBER