Provider Demographics
NPI:1073626941
Name:DENOUDEN, CHRIS K (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:K
Last Name:DENOUDEN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1300 DES MOINES ST
Mailing Address - Street 2:STE 103
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-5502
Mailing Address - Country:US
Mailing Address - Phone:515-266-5353
Mailing Address - Fax:515-266-2216
Practice Address - Street 1:1300 DES MOINES ST
Practice Address - Street 2:STE 103
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-5502
Practice Address - Country:US
Practice Address - Phone:515-266-5353
Practice Address - Fax:515-266-2216
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2009-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA01711207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0718900001OtherDME
IA1073626941OtherCEDI
IA0193847Medicaid
IA1073626941Medicare NSC
IA19384Medicare ID - Type Unspecified
IA1073626941OtherCEDI