Provider Demographics
NPI:1700860236
Name:IHLE, CHRISTOPHER LANGDON (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LANGDON
Last Name:IHLE
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 1:2740 N CLARKSON STREET
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-7720
Mailing Address - Country:US
Mailing Address - Phone:402-721-0090
Mailing Address - Fax:402-721-9661
Practice Address - Street 1:2740 N CLARKSON STREET
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-7720
Practice Address - Country:US
Practice Address - Phone:402-721-0090
Practice Address - Fax:402-721-9661
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15374207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE271565Medicare PIN
B59545Medicare UPIN