Provider Demographics
NPI:1023063930
Name:WING, CHRISTOPHER M (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:WING
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 1:3707 NEW VISION DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1702
Mailing Address - Country:US
Mailing Address - Phone:260-471-9466
Mailing Address - Fax:260-484-5919
Practice Address - Street 1:3707 NEW VISION DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1702
Practice Address - Country:US
Practice Address - Phone:260-471-9466
Practice Address - Fax:260-484-5919
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010465942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4074970100Medicaid
IN000000092602OtherANTHEM
IN7991OtherPHP
IN200147260Medicaid
OH2100587Medicaid
IN194930HMedicare ID - Type Unspecified
IN147380EMedicare ID - Type Unspecified
OHWI4111561Medicare ID - Type Unspecified
ING32662Medicare UPIN
IN7991OtherPHP
IN000000092602OtherANTHEM
IN925240PMedicare ID - Type Unspecified
OH2100587Medicaid
MI4074970100Medicaid
IN191150HMedicare ID - Type Unspecified
IN200147260Medicaid