Provider Demographics
NPI:1184727984
Name:MANNIX, CHRISTINA M (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:M
Last Name:MANNIX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:M
Other - Last Name:ARMBRECHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1465 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1003
Mailing Address - Country:US
Mailing Address - Phone:314-577-5395
Mailing Address - Fax:314-268-6459
Practice Address - Street 1:1465 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1003
Practice Address - Country:US
Practice Address - Phone:314-577-5395
Practice Address - Fax:314-268-6459
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108876208000000X
MO2007027356208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108876Medicaid
ILK17056Medicare ID - Type Unspecified
IL036108876Medicaid