Provider Demographics
NPI:1235393877
Name:CHRIST, MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:CHRIST
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 1:1000 HOLLISTER LN APT 1324
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-7299
Mailing Address - Country:US
Mailing Address - Phone:248-798-5966
Mailing Address - Fax:
Practice Address - Street 1:1000 HOLLISTER LN APT 1324
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-7299
Practice Address - Country:US
Practice Address - Phone:248-798-5966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.120769207P00000X
MI4301092989207P00000X
IN01069186207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000708215OtherANTHEM
INP00953680OtherRR MEDICARE
IN201023680Medicaid
INM400047679Medicare PIN