Provider Demographics
NPI:1821156092
Name:CHRISTMAN, KENNETH DANIEL (MD)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:DANIEL
Last Name:CHRISTMAN
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 1:2717 MIAMISBURG CENTERVILLE RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459
Mailing Address - Country:US
Mailing Address - Phone:937-435-5354
Mailing Address - Fax:937-435-5145
Practice Address - Street 1:2717 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:SUITE 212
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459
Practice Address - Country:US
Practice Address - Phone:937-435-5354
Practice Address - Fax:937-435-5145
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 0463592086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH33646OtherANTHEM
OH33646OtherANTHEM
OHCH0499832Medicare ID - Type Unspecified