Provider Demographics
NPI:1205085289
Name:LIENESCH, CHRISTOPHER PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:PAUL
Last Name:LIENESCH
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:WSU DEPT OF AEROSPACE MEDICINE
Mailing Address - Street 2:3640 COL GLENN HWY
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45435-0001
Mailing Address - Country:US
Mailing Address - Phone:937-775-1400
Mailing Address - Fax:
Practice Address - Street 1:3155 RESEARCH BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-4020
Practice Address - Country:US
Practice Address - Phone:937-775-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-10437208D00000X
OH57.022560390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice