Provider Demographics
NPI:1477543551
Name:MERNITZ, CHRISTOPHER S (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:S
Last Name:MERNITZ
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13420 N MERIDIAN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1581
Practice Address - Country:US
Practice Address - Phone:317-573-7050
Practice Address - Fax:317-573-7098
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045367A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200221750Medicaid
IN200221750Medicaid
IN677690CCCMedicare PIN
ING88459Medicare UPIN