Provider Demographics
NPI:1114922952
Name:THEUER, CHRISTOPHER J (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:THEUER
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 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-633-6062
Mailing Address - Fax:502-633-6810
Practice Address - Street 1:30 STONECREST CT
Practice Address - Street 2:STE 104
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8128
Practice Address - Country:US
Practice Address - Phone:502-633-6062
Practice Address - Fax:502-633-6810
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26764208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000048704OtherANTHEM BLUE CROSS
KYP01038669OtherRR MEDICARE
KY64267644Medicaid
KY0098506Medicare PIN
KYP01038669OtherRR MEDICARE
KY64267644Medicaid