Provider Demographics
NPI:1568677250
Name:MENKE, CHRISTOPHER ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ROBERT
Last Name:MENKE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:202 INSPERON DR STE 202
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-0602
Mailing Address - Country:US
Mailing Address - Phone:706-597-0102
Mailing Address - Fax:706-597-1998
Practice Address - Street 1:202 INSPERON DR STE 202
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-0602
Practice Address - Country:US
Practice Address - Phone:706-597-0102
Practice Address - Fax:706-597-1998
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001056213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52259761OtherBCBS
GA202I482383Medicare PIN