Provider Demographics
NPI:1972508703
Name:CLIMACO, CHRISTOPHER D (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:D
Last Name:CLIMACO
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 1:758 SOUTH WILLOW AVENUE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501
Mailing Address - Country:US
Mailing Address - Phone:931-526-6173
Mailing Address - Fax:931-526-5084
Practice Address - Street 1:758 SOUTH WILLOW AVENUE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501
Practice Address - Country:US
Practice Address - Phone:931-526-6173
Practice Address - Fax:931-526-5084
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD27239208000000X
TN272392080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMD27239OtherSTATE LICENSE NUMBER
TNMD27239OtherSTATE LICENSE NUMBER
TNMD27239OtherSTATE LICENSE NUMBER
TN3099086Medicare ID - Type Unspecified