Provider Demographics
NPI:1669475281
Name:PELZEK, CHRISTOPHER DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:PELZEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8679 CONNECTICUT ST
Mailing Address - Street 2:STE A
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6383
Mailing Address - Country:US
Mailing Address - Phone:219-769-9022
Mailing Address - Fax:219-769-1918
Practice Address - Street 1:8679 CONNECTICUT ST
Practice Address - Street 2:STE A
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6383
Practice Address - Country:US
Practice Address - Phone:219-769-9022
Practice Address - Fax:219-769-1918
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01056390A174400000X
IL036106763207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200376140Medicaid
INH31149Medicare UPIN
IN496710KMedicare ID - Type Unspecified
IN200376140Medicaid