Provider Demographics
NPI:1922041615
Name:NELSON, CHRISTOPHER S (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:S
Last Name:NELSON
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 1:10706 E US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7982
Mailing Address - Country:US
Mailing Address - Phone:317-271-3600
Mailing Address - Fax:317-271-3604
Practice Address - Street 1:10706 E US HIGHWAY 36
Practice Address - Street 2:SUITE # 7
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7982
Practice Address - Country:US
Practice Address - Phone:317-271-3600
Practice Address - Fax:317-271-3604
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050912A207L00000X, 207RG0300X, 208D00000X
MI4301090162207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200231960Medicaid
IN218790AMedicare ID - Type Unspecified
INH25167Medicare UPIN