Provider Demographics
NPI:1356436414
Name:LEAGRE, CHRISTOPHER ALAN (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ALAN
Last Name:LEAGRE
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 1:6100 W 96TH ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-6005
Mailing Address - Country:US
Mailing Address - Phone:317-715-1800
Mailing Address - Fax:317-715-6200
Practice Address - Street 1:8301 HARCOURT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260
Practice Address - Country:US
Practice Address - Phone:317-415-6760
Practice Address - Fax:317-415-6758
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010391812085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100329980Medicaid
IN200259350Medicaid
IN01039181BOtherCSR
INBL1732482OtherDEA
IN677730FFFMedicare PIN
IN149720BBMedicare PIN
IN366480DMedicare PIN
E83683Medicare UPIN
IN246800Medicare PIN
INBL1732482OtherDEA
IN200259350Medicaid