Provider Demographics
NPI:1518921444
Name:THORESEN, CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:THORESEN
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 1:4685 FOREST AVE
Mailing Address - Street 2:STE C
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3359
Mailing Address - Country:US
Mailing Address - Phone:513-366-4488
Mailing Address - Fax:513-366-4480
Practice Address - Street 1:10506 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4487
Practice Address - Country:US
Practice Address - Phone:513-792-7800
Practice Address - Fax:513-792-7807
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058470207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
2520404OtherUNITED
39948894005OtherMEDICAL MUTUAL OF OHIO
283926OtherAMERIGROUP
IN100350220Medicaid
000000019929OtherANTHEM
OH0875003Medicaid
11438871058OtherCARESOURCE
58470-13OtherHUMANA
0645403OtherAETNA
KY64869753Medicaid
OHP00023081OtherRAILROAD MEDICARE
IN100350220Medicaid
OH0711644Medicare PIN
OH0711642Medicare PIN
0645403OtherAETNA
OH0896413Medicare PIN