Provider Demographics
NPI:1184679847
Name:SADEH, CHRISTOPHER WILSON (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:WILSON
Last Name:SADEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5519 WILLOW WOOD LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-2658
Mailing Address - Country:US
Mailing Address - Phone:972-846-9550
Mailing Address - Fax:817-764-0682
Practice Address - Street 1:17762 PRESTON RD STE 111
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5808
Practice Address - Country:US
Practice Address - Phone:972-846-9550
Practice Address - Fax:817-764-0682
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9881207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0075PTOtherBCBS
H72846Medicare UPIN
TX611193Medicare PIN