Provider Demographics
NPI:1437293453
Name:CHRISSOHERIS, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:CHRISSOHERIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 CHAPEL ST
Mailing Address - Street 2:HSR SECTION OF CARDIOLOGY PRIVATE 207
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4405
Mailing Address - Country:US
Mailing Address - Phone:203-789-6045
Mailing Address - Fax:203-789-6046
Practice Address - Street 1:1450 CHAPEL ST
Practice Address - Street 2:HSR SECTION OF CARDIOLOGY PRIVATE 207
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4405
Practice Address - Country:US
Practice Address - Phone:203-789-6045
Practice Address - Fax:203-789-6046
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT040718208M00000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001407180Medicaid
BC8575384OtherFED DEA
CT110009074Medicare ID - Type Unspecified
BC8575384OtherFED DEA