Provider Demographics
NPI:1265655948
Name:HANLEY, CHRISTOPHER G (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:G
Last Name:HANLEY
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 1:2400 S. MINNESOTA AVE.
Mailing Address - Street 2:STE. 100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-3762
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:4400 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8170
Practice Address - Country:US
Practice Address - Phone:605-322-5709
Practice Address - Fax:605-322-5831
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV240072084P0800X
SD84552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7102960Medicaid
SDP01092150OtherRR MEDICARE
SD7102960Medicaid