Provider Demographics
NPI:1104838309
Name:WIRSING, CHRISTOPHER M (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:WIRSING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 EASTPORT CENTRE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2909
Mailing Address - Country:US
Mailing Address - Phone:219-464-0409
Mailing Address - Fax:219-464-2376
Practice Address - Street 1:880 EASTPORT CENTRE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2909
Practice Address - Country:US
Practice Address - Phone:219-464-0409
Practice Address - Fax:219-464-2376
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000885A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100209730AMedicaid
D95567Medicare UPIN
IN100209730AMedicaid