Provider Demographics
NPI:1154593259
Name:MIDDENDORF, CHRISTOPHER MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:MIDDENDORF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-2686
Mailing Address - Fax:850-416-2684
Practice Address - Street 1:1549 AIRPORT BLVD
Practice Address - Street 2:SUITE 430
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8633
Practice Address - Country:US
Practice Address - Phone:850-416-2686
Practice Address - Fax:850-416-2684
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12841207LP2900X
OH34.010929207LP2900X
IN02004088A207LP2900X
KY03523207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201262710Medicaid
ININ2019001Medicare PIN
OHH209282Medicare PIN