Provider Demographics
NPI:1134123748
Name:SPIEKERMAN, CHRISTOPHER (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:SPIEKERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4137 N 108TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037
Mailing Address - Country:US
Mailing Address - Phone:623-877-7337
Mailing Address - Fax:623-772-0686
Practice Address - Street 1:4137 N 108TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5459
Practice Address - Country:US
Practice Address - Phone:623-877-7337
Practice Address - Fax:623-772-0686
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3650208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ597370Medicaid