Provider Demographics
NPI:1639146749
Name:FORMANEK, CHRISTOPHER B (DPM)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:B
Last Name:FORMANEK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6141 PARKFOREST DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6111
Mailing Address - Country:US
Mailing Address - Phone:225-756-0034
Mailing Address - Fax:225-756-0708
Practice Address - Street 1:6141 PARKFOREST DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-6111
Practice Address - Country:US
Practice Address - Phone:225-756-0034
Practice Address - Fax:225-756-0708
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD321R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist