Provider Demographics
NPI:1558374876
Name:BRETZ, CHRISTOPHER JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:BRETZ
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:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:IN
Mailing Address - Zip Code:46737-0626
Mailing Address - Country:US
Mailing Address - Phone:260-668-6921
Mailing Address - Fax:
Practice Address - Street 1:804 SPRING HILL CT
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:IN
Practice Address - Zip Code:46737-7625
Practice Address - Country:US
Practice Address - Phone:260-668-6921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058292A207Q00000X
OH35059563B207Q00000X
IN01058292B171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200508530AMedicaid
E86938Medicare UPIN
IN200508530AMedicaid
INM400065155Medicare PIN