Provider Demographics
NPI:1639147408
Name:SANDBERG, CHRIS B (MD)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:B
Last Name:SANDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1515 SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64505-2631
Mailing Address - Country:US
Mailing Address - Phone:816-233-3338
Mailing Address - Fax:816-233-4777
Practice Address - Street 1:1515 ST JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:ST JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64505-2631
Practice Address - Country:US
Practice Address - Phone:816-233-3338
Practice Address - Fax:816-233-4777
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO35550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202117610Medicaid
MO202117610Medicaid
MO202117610Medicaid
F299853AMedicare ID - Type Unspecified
N66000003Medicare Oscar/Certification
AS7555103OtherDEA