Provider Demographics
NPI:1144233347
Name:STOCK, CHRISTOPHER JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOSEPH
Last Name:STOCK
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 1:4070 CHICAGO DR SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-1258
Mailing Address - Country:US
Mailing Address - Phone:616-988-8787
Mailing Address - Fax:616-988-4786
Practice Address - Street 1:4070 CHICAGO DR SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1258
Practice Address - Country:US
Practice Address - Phone:616-988-8787
Practice Address - Fax:616-988-4786
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICS065698207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1804112891OtherBCBS PROVIDER #
MI104749142Medicaid
MI104531620Medicaid
MI200033734OtherTAX ID
MIG99082Medicare UPIN
MI1804112891OtherBCBS PROVIDER #